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Memory

preserving your Winter 2008

The Magazine of Health and Hope

Stages of Alzheimer’s
How Your Doctor Will
Caregiving and the Flu Determine a Diagnosis
Olympic Gold Medalist Teaching the Art of
Kristi Yamaguchi Caregiving
Wants You to Protect An Innovative Program in
Yourself This Winter Community Colleges Is Making
a Big Difference Nationwide
ALZinfo.org: Visit Our Newly Redesigned
Website for More Alzheimer’s Resources
We have redesigned our website, ALZinfo.org, to include more resources
and make it easier for you to navigate!

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Features
Stages of Alzheimer’s
New York University’s Dr. Barry Reisberg
outlines the seven major clinical stages of
Alzheimer’s disease.

8
Caregivers in Training
Funded by grants from the MetLife Foundation, the
Community College Caregiver Training Initative—an
innovative nationwide program—is training caregivers at
our nation’s community colleges.

16
The Flu and You
Caregivers need to know that it’s flu season,
and Olympic Gold Medalist Kristi Yamaguchi
says a flu vaccine should be on your schedule if
you haven’t already had one. Learn why the flu
vaccine is a necessity for Alzheimer’s caregivers
(and patients).
24
winter 2008 www.ALZinfo.org 3
Contents
Preserving Your Memory received a
Bronze Award in the “Health Promotion/
Disease Prevention Information—Magazine”
category at the 2008 National Health
Information AwardsSM.

5 From the Editor’s Desk West 46th Street & 12th Avenue, New York, NY 10036
1-800-ALZ-INFO • www.ALZinfo.org
Winter brings with it a time for reminiscence, for
closeness and togetherness. Michael Stern, Publisher
Betsey Odell, Editor in Chief
6 News Briefs Alan White, Managing Editor
Read the latest news on Alzheimer’s disease and William J. Netzer, PhD, Science Editor
brain health. Jerry Louis, Graphic Designer
Toby Bilanow, Bernard A. Krooks, Contributing Writers
8 Stages of Alzheimer’s
14 Food and Nutrition
New Year’s brings the perfect opportunity to make a
change to your diet.

16 Caregivers in Training
© Copyright 2008 by the Fisher Center for Alzheimer’s Research Foundation.
No part of this publication may be reproduced or transmitted in any form or by
20 Caregiver Voices any means without written permission from the Fisher Center for Alzheimer’s
A son points out the importance of keeping it simple. Research Foundation. Articles in this publication are written by professional
journalists who strive to present reliable, up-to-date health information.
However, personal decisions regarding health, finance, exercise, and other
22 Ask the Experts matters should be made only after consultation with the reader’s physician or
professional adviser. All editorial rights reserved. Opinions expressed herein are
Your questions answered by Dr. Dede Bonner, not necessarily those of the Fisher Center for Alzheimer’s Research Foundation.
This project was supported, in part, by a grant, number 90AZ2791, from the
author of The 10 Best Questions™ for Living with Administration on Aging, Department of Health and Human Services. Grantees
Alzheimer’s. undertaking projects under government sponsorship are encouraged to express
freely their findings and conclusions. Points of view or opinions do not, therefore,
necessarily represent official Administration on Aging policy.
24 The Flu and You
28 Fisher Center Research
A breakthrough in Alzheimer’s and Parkinson’s
research.
Preserving Your Memory is published by
30 Fitness Vitality Communications
Simple yoga exercises for caregivers and patients. 407 Norwalk St., Greensboro, NC 27407 (336) 547-8970

Sam Gaines, Managing Editor


32 Long-Term Planning Traci Shelton, Senior Art Director
Attorney Bernard A. Krooks explains third-party Kathy White, Account Manager
special-needs trusts. Jan McLean, Creative Director
Traci Marsh, Production Director
34 Keeping Your Mind Sharp Ginny Gaylor, Jennifer Sellers, Michelle Porter Tiernan,
Give your brain a workout with these brainteasers. Contributing Writers

38 Medicinal Laughter Cover photo: Yuki Saegusa, IMG/John Russo


Agnes the Wellness Woman is back!
Made possible by a grant from

A leader in finding an Alzheimer’s cure

4 Preserving Your Memory winter 2008


From the Editor’s Desk

Looking Back, Looking Ahead

W
inter is a time of reminiscence as we celebrate the traditions
and togetherness that make the Holidays special every
year. But it’s also a time of looking ahead as we approach
a new year and the promise of a cure and even better treatments for
Alzheimer’s disease.
Alzheimer’s is a progressive disease that has distinctive stages of
development, and we review the stages of Alzheimer’s beginning on
page 8. We also learn about a nationwide caregiver training initiative
(page 16) that takes advantage of our network of community colleges
to fill a rapidly growing need. And we explore the impact of influenza
on caregivers in our cover story, “The Flu and You” (page 24).
As we move into 2009, we consider what changes we can all make
to our diet in order to benefit mind and memory. “Food Resolutions”
Betsey Odell
(page 14) encourages us to consider making healthier choices in the
new year and offers some ideas for helping those efforts succeed. And
we take a look at a simple exercise that can make a big difference for caregivers and patients alike: yoga
(page 30).
Winter is the perfect season for bundling up with this issue of Preserving Your Memory.

Please send your tips, stories, or questions to the Fisher Center for
Alzheimer’s Research Foundation, West 46th St. & 12th Ave.,
New York, NY 10036, or by e-mail to betsey@alzinfo.org
Betsey Odell
Editor in Chief

For advertising information, please contact:


Betsey Odell Kathy White
Fisher Center Foundation Vitality Communications
(646) 381-5148 (336) 547-8970, ext. 3327

About the Fisher Center for Alzheimer’s Research Foundation


Since 1995, the Fisher Center Foundation, a 501(c)(3) nonprofit organization, has been providing
hope and help to the public by funding research into the cause, care, and cure of Alzheimer’s
disease and creating much needed educational programs. We are the world’s largest research
team leading the battle against Alzheimer’s disease. Our team of internationally renowned
scientists, under the direction of Nobel laureate Dr. Paul Greengard, has been at the forefront of
research that has provided a conceptual framework for modern-day investigations into Alzheimer’s
disease. Of every dollar we raise, 94 cents goes directly to research programs. Oprah’s O Magazine
lists us as the top charity to give to for Alzheimer’s. For more information or to make a donation, go
to www.ALZinfo.org.

winter 2008 www.ALZinfo.org 5


News Briefs

The Latest News on Alzheimer’s Disease


and Brain Health
Gingko, an Herbal aspirin and warfarin, raising the risk
Supplement, Shows of dangerous bleeding. In the current
No Benefit in Preventing study, people who were taking blood-
Alzheimer’s Disease thinners or who had other blood con-
Millions of older Americans take ditions were excluded from the study.
the herb ginkgo biloba in the hopes of There is evidence suggesting that ging-
warding off senior moments and the ko increases the risk for stroke due to
onset of Alzheimer’s disease as well. bleeding in the brain.
But a rigorous new study involving
thousands of seniors found that supple- Counseling, Support
ments containing the herb did nothing Helps Alzheimer’s
to ward off the onset of the memory- Gingko biloba showed no effect Caregivers Everywhere
robbing ailment. This contradicts on the onset of Alzheimer’s. A caregiver of a patient taking medi-
several smaller, previous studies that cation for Alzheimer’s disease will
claimed benefits for gingko biloba. over the course of the study. Demen- benefit from counseling and support
The study, conducted by researchers tia developed in 246 of those receiv- services, an international study has
at five medical centers across the coun- ing placebo, compared to 277 in the found.
try, involved more than 3,000 men and ginkgo group. Nearly 10 million Americans care for
women aged 75 and older. Most were The trial, called the Ginkgo Evalua- someone with Alzheimer’s. This study
mentally intact at the start of the study tion of Memory, or GEM, study, was looked at 158 older men and women
in 2000, though some in each group the largest to date to evaluate the herb. who are caregivers at home for a spouse
had mild cognitive impairment, a form The findings were published in JAMA, with the disease. All Alzheimer’s pa-
of memory loss that is far less severe the Journal of the American Medical As- tients were taking donepezil (Ari-
than Alzheimer’s but which may prog- sociation. cept) as part of the study. One group
ress to Alzheimer’s with time. Although the current study was well of caregivers was given a combination
Participants were divided into two designed and gave compelling results, of educational programs, counseling
groups. Half took a standardized extract it still appears that there is uncertainty and ongoing support, in contrast with
of ginkgo, at a dose of 120 mg twice a as to whether gingko biloba may be of a control group that received none.
day, for an average of six years. The oth- benefit in Alzheimer’s disease under Researchers found that symptoms of
ers took a look-alike placebo. All were some circumstances. For example, the depression among caregivers were re-
given memory tests and check-ups at study participants were all over 75 years duced in the group that received the
six-month intervals to look for signs of of age, and some of those who were additional support.
Alzheimer’s disease. Brain scans were cognitively intact at the beginning of “These findings show that counsel-
also performed if it was suspected that the study may have already had early, ing and support of family members can
someone might have Alzheimer’s. preclinical Alzheimer’s disease. Thus, be of significant benefit to Alzheimer’s
The researchers found that by the it is unknown whether gingko given to caregivers even when the patients are
time the study was completed in 2008, younger individuals for a longer period receiving medications for the disease.
there was no difference in the rates of of time could be of benefit. Caregivers who are less depressed
Alzheimer’s onset between the group Experts caution that anyone tak- are better able to take care of their ill
taking ginkgo and the group taking ing ginkgo or products containing the family members,” said Mary Mittel-
a placebo. Of the 3,069 people in the herb should let their doctors know. It man, Dr.P.H., director of the Psycho-
study, 523 were given a diagnosis of Al- may interact with prescription or over- social Research and Support Program
zheimer’s or another form of dementia the-counter medications, including at the New York University School of
6 Preserving Your Memory winter 2008
Medicine Silverstein Institute. She also certain liver enzymes that break down nosis, and treatment of AD
serves on the Editorial Advisory Board drugs in the body. As a result, it may • What caregivers and families need to
for www.ALZinfo.org, the Fisher Cen- alter the effects of certain drugs. Con- know
ter for Alzheimer’s Research Founda- sult your doctor before deciding to take The book is available for free down-
tion’s website. grape seed extract. load and online viewing. A free printed
copy can be ordered by going to nia.
Merck Compound Falters nih.gov, or calling NIA’s Alzheimer’s
in Human Trial Disease Education and Referral Center
MK-677, a new compound that had at 800-438-4380.
shown promise in slowing the growth

©2007 USPS. All Rights Reserved.


of sticky plaques in mouse brains, does Suspect Genes Identified
not have the same effect in humans, in Study
research has found. Four genes that may contribute to
The compound showed great prom- the development of the most common
ise in stimulating the release of a type of late-onset Alzheimer’s dis-
chemical called Insulin-like Growth ease have been identified by a survey
Factor-1 (IGF-1), which slows the ac- of the genome, according to research
cumulationof beta amyloid protein in published in The American Journal of
mice. Beta amyloid protein is the sub- Human Genetics. Only one gene has
stance that forms the sticky plaques in The new Alzheimer’s postage previously been linked definitively to
the brain that are associated with Al- stamp is currently available. late onset Alzheimer’s.
zheimer’s. This study is the initial result of an
In the study, participants with mild ongoing Alzheimer’s Genome Proj-
to moderate Alzheimer’s showed no Alzheimer’s Postage ect, which is supported by the Cure
improvement in memory skills after Stamp Debuts Alzheimer’s Fund and the National
receiving MK-677, as compared to the The United States Postal Service Institute of Mental Health. Scientists
placebo group. The research may put a unveiled its new Alzheimer’s disease looked at nearly a half-million markers
damper on studies of using the IGF-1 stamp in October at a ceremony in covering most of the human genome
system alone as a way of approaching Morgantown, W.Va. The new stamp from a sample of 300 families, each of
Alzheimer’s symptoms in clinical re- honors caregivers with the phrase, “care which have at least three family mem-
search. – support – research.” bers with late-onset AD.
The 42-cent first-class stamp is cur- “Virtually all current research into
Grape Seed Extract May Have rently available at post offices nation- therapies is based on the Alzheimer’s
Applications in Alzheimer’s wide and through the USPS website genes that we already know about; so
Grape seeds—a rich source of anti- (www.usps.gov). each new gene we find not only en-
oxidants—showed promise in dimin- hances our ability to predict and di-
ishing amyloid-beta deposits in the Alzheimer’s Book agnose the disease, but also provides
brain in laboratory mice and improv- Updated, Free valuable new clues about biochemical
ing their memory, according to recent Alzheimer’s Disease: Unraveling the events and pathways involved in the
research. The study out of Mount Si- Mystery, an 80-page book from the Na- disease process,” said Rudolph Tanzi,
nai School of Medicine looked at the tional Institute on Aging, has been reis- Ph.D., director of the MGH-MIND
effects of feeding grape-seed extract to sued as an updated version of the 2003 Genetics and Aging Research Unit.
mice that were given a gene that causes original. The book is aimed at those Tanzi was a co-discoverer of early-onset
their brains to produce high levels of living with Alzheimer’s, their families, Alzheimer’s genes and is a pioneer in
beta-amyloid, the substance that accu- healthcare professionals and anyone the search for genes that influence the
mulates in Alzheimer’s disease. with an interest in the disease. more common late onset, or sporadic
Other studies suggest that grape The book explains: form of Alzheimer’s. ■
seed extract may be of benefit in some • How a healthy brain works
cancers and in cardiovascular disease. • The changes that occur when AD af- Check the Fisher Center website
It should be cautioned however, that fects the brain (www.ALZinfo.org) often for up-to-date
grape seed extract is known to inhibit • New research into the causes, diag- and expert-reviewed scientific news.
winter 2008 www.ALZinfo.org 7
By Dr. Barry Reisberg

Clinical Stages of Alzheimer’s


Disease
A
lzheimer’s disease (AD) is a
characteristic process with
readily identifiable clinical
stages. These clinical stages exist
in a continuum with normal aging
processes. The clinical stages of AD
can be described in alternative ways.
For example, they can be described
globally or they can be described in
terms of constituent elements, referred
to as clinical axes. One of these clinical
axes, functioning and self-care, is
particularly useful in describing the
progression of AD. However, many
conditions, particularly in aged persons,
can interfere with functioning apart
from AD. For these and other reasons,
functioning changes alone do not
adequately describe the progress of
AD. However, the combination of
global changes and their functional
concomitants can provide a clear map
or the progress of AD. This clinical
map is enriched by noting the common
behavioral concomitants of the stages.
However, the behavioral and mood
manifestations of AD are much more
diverse than the cognitive and functional
features of the disease progression.
Globally, seven major stages from
normality to most severe AD are Cognitively challenging games can help prevent
identifiable. Functionally, 16 stages and the onset of Alzheimer’s.
substages corresponding to the global
stages are recognizable. These global and
functional clinical stages and substages We call these mentally healthy persons at any age, stage 1,
of aging and AD are summarized as follows. or normal.

Stage 1: Normal Stage 2: Normal aged forgetfulness


At any age, persons may potentially be free of objective Half or more of the population of persons over the age
or subjective symptoms of cognition and functional decline of 65 experience subjective complaints of cognitive and/
and also free of associated behavioral and mood changes. or functional difficulties. The nature of these subjective
8 Preserving Your Memory winter 2008
complaints is characteristic. Elderly persons with these course of many years. However, in a majority of persons
symptoms believe they can no longer recall names as well with stage 3 symptoms, overt decline will occur, and
as they could 5 or 10 years previously. They also frequently clear symptoms of dementia will become manifest over
develop the conviction that they can no longer recall where intervals of approximately 2 to 4 years. In persons who are
they have placed things as well as previously. Subjectively not called upon to perform complex occupational and/
experienced difficulties in concentration and in finding the or social tasks, symptoms in this stage may not become
correct word when speaking, are also common. evident to family members or friends of the MCI patient.
Various terms have been suggested for this condition, but Even when symptoms do become noticeable, MCI subjects
normal aged forgetfulness is probably the most satisfactory are commonly midway or near the end of this stage before
terminology. These symptoms, which by definition, are concerns result in clinical consultation. Consequently,
not notable to intimates or other external observers of although progression to the next stage in MCI subjects
the person with normal aged forgetfulness, are generally commonly occurs in 2 to 3 years, the true duration of
benign. However, there is some recent evidence that this stage, when it is a harbinger of subsequently manifest
persons with these symptoms do decline at greater rates dementia, is probably approximately 7 years.
than similarly aged persons and similarly healthy persons Management of persons in this stage includes counseling
who are free of subjective complaints. regarding the desirability of continuing in a complex and
demanding occupational role. Sometimes, a “strategic
Stage 3: Mild withdrawal” in the
cognitive form of retirement, may
impairment alleviate psychological
Persons at this stage stress and reduce both
manifest deficits which subjective and overtly
are subtle, but which are manifest anxiety.
noted by persons who are
closely associated with the Stage 4: Mild
stage 3 subject. The subtle Alzheimer’s
deficits may become disease
manifest in diverse ways. Symptoms of
For example, the person impairment become
with mild cognitive evident in this stage.
impairment (MCl) may For example, seemingly
noticeably repeat queries. major recent events,
The capacity to perform such as a recent holiday
Mild cognitive impairment (stage 3) may produce a
executive functions also or a recent visit to a
becomes compromised. decline in learning and organizational skills. relative, may, or may not,
Commonly, for persons be recalled. Similarly,
who are still working, job performance may decline. For overt mistakes in recalling the day of the week, month
those who must master new job skills, decrements in these or season of the year may occur. Patients at this stage
capacities may become evident. For example, the MCI can still generally recall their correct current address.
subject may be unable to master new computer skills. MCI They can also generally correctly recall the weather
subjects who are not employed, but who plan complex conditions outside and very important current events,
social events, such as dinner parties, may manifest declines such as the name of a prominent head of state. Despite the
in their ability to organize such events. Other MCI subjects overt deficits in cognition, persons at this stage can still
may manifest concentration deficits. Many persons with potentially survive independently in community settings.
these symptoms begin to experience anxiety, which may be However, functional capacities become compromised in
overtly evident. the performance of instrumental (i.e., complex) activities
The prognosis for persons with these subtle symptoms of daily life. For example, there is a decreased capacity to
of impairment is variable, even when a select subject manage personal finances. For the stage 4 patient who is
group who are free of overt medical or psychological living independently, this may become evident in the form
conditions which might account for, or contribute to, the of difficulties in paying rent and other bills. A spouse may
impairments are studied. A substantial proportion of these note difficulties in writing the correct date and the correct
persons will not decline, even when followed over the amount in paying checks. The ability to independently
winter 2008 www.ALZinfo.org 9
market for food and groceries also becomes compromised from the beginning of this stage. Studies indicate that
in this stage. Persons who previously prepared meals for the duration of this stage of mild AD is a mean of
family members and/or guests begin to manifest decreased approximately 2 years.
performance in these skills. Similarly, the ability to order
food from a menu in a restaurant setting begins to be Stage 5: Moderate Alzheimer’s disease
compromised. Frequently, this is manifest in the patient At this stage, deficits are of sufficient magnitude as to
handing the menu to the spouse and saying ‘you order’. prevent independent and catastrophe-free community
The dominant survival. Patients
mood at this stage can no longer
is frequently what manage on
psychiatrists term a their own in the
flattening of affect community. If they
and withdrawal. In are ostensibly alone
other words, the in the community
patient often seems then there is
less emotionally generally someone
responsive than who is assisting in
previously. providing adequate
This absence and proper food,
of emotional as well as assuring
responsivity is that the rent and
probably intimately utilities are paid
related to the and the patient’s
patient’s denial finances are
of their deficit, taken care of. For
which is often also those who are not
notable at this properly watched
stage. Although and/or supervised,
the patient is aware predatory strangers
of their deficits, may become a
this awareness problem. Very
of decreased common reactions
intellectual for persons at
capacity is too this stage who
painful for most are not given
persons and, hence, adequate support
the psychological are behavioral
defense mechanism problems such
known as denial, as anger and
whereby the patient suspiciousness.
seeks to hide Cognitively,
their deficit, even persons at this stage
from themselves frequently cannot
where possible, recall such major
becomes operative. Reading is an important skill for preserving your memory. events and aspects
In this context, of their current
the flattening of lives as the name
affect occurs because the patient is fearful of revealing of the current U. S. president, the weather conditions of the
their deficits. Consequently, the patient withdraws from day, or their correct current address. Characteristically, some
participation in activities such as conversations. of these important aspects of current life are recalled, but not
In the absence of complicating medical pathology, the others. Also, the information is loosely held, so, for example,
diagnosis of AD can be made with considerable certainty the patient may recall their correct address on certain
10 Preserving Your Memory winter 2008
occasions, but not others. to manage independently the mechanics of toileting
Remote memory also suffers to the extent that persons correctly (stage 6c). Unless supervised, patients may place
may not recall the names of some of the schools which they the toilet tissue in the wrong place. Many patients will
attended for many years, and from which they graduated. forget to flush the toilet properly. As the disease evolves
Orientation may be compromised to the extent that the in this stage, patients subsequently become incontinent.
correct year may not be recalled. Calculation deficits are Generally, urinary incontinence occurs first (stage 6d),
of such magnitude that an educated person has difficulty then fecal incontinence occurs (stage 6e). The incontinence
counting backward from 20 by 2s. can be treated, or even initially prevented entirely in many
Functionally, persons at this stage have incipient cases, by frequent toileting. Subsequently, strategies for
difficulties with basic activities of daily life. The managing incontinence, including appropriate bedding,
characteristic deficit of this type is decreased ability to absorbent undergarments, etc., become necessary.
independently choose proper clothing. This stage lasts an In this sixth stage cognitive deficits are generally so
average of approximately 1.5 years. severe that persons will display little or no knowledge

Stage 6: Moderately severe


Alzheimer’s disease Patients at stage 4 may display a “flattening”
At this stage, the ability to perform of emotional responses.
basic activities of daily life becomes
compromised. Functionally, five
successive substages are identifiable.
Initially, in stage 6a, patients, in addition
to having lost the ability to choose their
clothing without assistance, begin to
require assistance in putting on their
clothing properly. Unless supervised,
patients may put their clothing on
backward, they may have difficulty
putting their arm in the correct sleeve, or
they may dress themselves in the wrong
sequence.
For example, patients may put their
street clothes on over their night clothes.
At approximately the same point in
the evolution of AD, but generally just
a little later in the temporal sequence,
patients lose the ability to bathe
independently without assistance (stage
6b). Characteristically, the earliest and
most common deficit in bathing is
difficulty adjusting the temperature of
the bath water. Initially, once the spouse
adjusts the temperature of the bath water,
the patient can still potentially otherwise
bathe independently. Subsequently, as
this stage evolves, additional deficits
in bathing independently as well as in
dressing independently occur. In this
6b substage, patients generally develop
deficits in other modalities of daily
hygiene such as properly brushing their
teeth independently. With the further
evolution of AD, patients lose the ability
winter 2008 www.ALZinfo.org 11
when queried regarding such major aspects of their current basis, they are also clearly related to the patient’s
life circumstances as their current address or the weather psychological reaction to their circumstances. For
conditions of the day. example, because of their cognitive deficits, patients can
Recall of current events is generally deficient to the no longer channel their energies into productive activities.
extent that the patient cannot name the current national Consequently, unless appropriate direction is provided,
head of state or patients begin to
other, similarly fidget, to pace,
prominent to move objects
newsworthy around and place
figures. Persons at items where they
this sixth stage will may not belong,
most often not be or to manifest
able to recall the other forms of
names of any of purposeless or
the schools which inappropriate
they attended. activities. Because
They may, or may of the patient’s
not, recall such fear, frustration
basic life events and shame
as the names of regarding their
their parents, their circumstances,
former occupation as well as other
and the country factors, patients
in which they frequently develop
were born. They verbal outbursts,
still have some and threatening,
knowledge of or even violent,
their own names; behavior may
however, patients occur. Because
in this stage begin patients can no
to confuse their longer survive
spouse with their independently, they
deceased parent commonly develop
and otherwise a fear of being left
mistake the alone. Treatment
identity of persons, of these and other
even close family behavioral and
members, in their psychological
own environment. symptoms which
Calculation ability occur at this stage,
is frequently as well as at other
so severely stages of AD,
compromised involves counseling
at this stage regarding
that even well- appropriate
educated patients Patients at stage 6 often become afraid of being alone. activities and the
have difficulty psychological
counting backward impact of the
consecutively from 10 by 1s. illness upon the patient, as well as pharmacological
Emotional changes generally become most overt and interventions.
disturbing in this sixth stage of AD. Although these The mean duration of this sixth stage of AD is
emotional changes may, in part, have a neurochemical approximately 2.3 years. As this stage comes to an end, the
12 Preserving Your Memory winter 2008
patient, who is doubly incontinent and needs assistance physical and neurological changes become increasingly
with dressing and bathing, begins to manifest overt evident. One of these changes is physical rigidity. Evident
breakdown in the ability to articulate speech. Stuttering rigidity upon examination of the passive range of motion
(verbigeration), neologisms, and/or an increased paucity of of major joints, such as the elbow, is present in the great
speech, become manifest. majority of patients, throughout the course of the seventh
stage. In many patients, this rigidity appears to be a
Stage 7: Severe Alzheimer’s disease precursor to the appearance of overt physical deformities
At this stage, AD patients require continuous assistance in the form of contractures. Contractures are irreversible
with basic activities of daily life for survival. Six consecutive deformities which prevent the passive or active range
functional substages can be identified over the course of of motion of joints. In the early seventh stage (7a and
this final seventh stage. Early in this stage, speech has 7b), approximately 40% of AD patients manifest these
become so circumscribed, as to be limited to approximately deformities. Later in the seventh stage, in immobile
a half dozen intelligible words or fewer in the course of patients (from stage 7d to 7f), nearly all AD patients
an intensive contact and attempt at an interview with manifest contractures in multiple extremities and joints.
numerous queries (stage 7a). As this stage progresses, speech Neurological reflex changes also become evident in the
becomes even more limited to, at most, a single intelligible stage 7 AD patient. Particularly notable is the emergence of
word (stage 7b). Once speech is lost, the ability to ambulate so-called ‘infantile’, ‘primitive’ or ‘developmental’ reflexes
independently (without assistance), is invariably lost (stage which are present in the infant but which disappear in the
7e). However, ambulatory ability is readily compromised toddler. These reflexes, including the grasp reflex, sucking
at the end of the sixth stage and in the early portion of reflex, and the Babinski plantar extensor reflex, generally
the seventh stage by concomitant physical disability, poor begin to re-emerge in the latter part of the sixth stage and
care, medication side-effects or other factors. Conversely, are usually present in the stage 7 AD patient. Because of
superb care provided in the early seventh stage, and the much greater physical size and strength of the AD
particularly in stage 7b, can postpone the onset of loss of patient in comparison with an infant, these reflexes can be
ambulation, potentially for many years. However, under very strong and can impact both positively and negatively
ordinary circumstances, stage 7a has a mean duration of on the care provided to the AD patient. AD patients
approximately 1 year, and stage 7b has a mean duration of commonly die during the course of the seventh stage. The
approximately 1.5 years. mean point of demise is when patients lose the ability to
In patients who remain alive, stage 7c lasts approximately ambulate and to sit up independently (stages 7c and 7d).
1 year, after which patients lose the ability not only to The most frequent proximate cause of death is
ambulate independently, but also to sit up independently pneumonia. Aspiration is one common cause of terminal
(stage 7d). At this point in the evolution of AD, patients pneumonia. Another common cause of demise in AD is
will fall over when seated unless there are arm rests to infected decubital ulcerations. AD patients in the seventh
hold the patient up in the chair. This 7d substage lasts stage appear to be more vulnerable to all of the common
approximately 1 year. Patients who survive subsequently causes of mortality in the elderly including stroke, heart
lose the ability to smile (stage 7e). At this substage only disease and cancer. Some patients in this final stage appear
grimacing facial movements are observed in place of smiles. to succumb to no identifiable condition other than AD. ■
This 7e substage lasts a mean of approximately 1.5 years. It
is followed in survivors, by a final 7f substage, in which AD From:
patients additionally lose the ability to hold up their head The Encyclopedia of Visual Medicine Series
independently. An Atlas of Alzheimer’s Disease,
In the latter portion of the final stage of AD, patients Parthenon, Pearl River (NY),
become immobile co the extent that they require support Edited by Mony J. de Leon
to sit up without falling. With the advance of this stage,
patients lose the ability to smile and, ultimately, to hold up Dr. Barry Reisberg is the Clinical Director of New York
their head without assistance, unless their neck becomes University’s Aging and Dementia Research Center. As the
contracted and immobile. Patients can survive in this final principal investigator of studies conducted by the National
7f substage indefinitely; however, most patients succumb Institutes of Health, Dr. Reisberg’s work has been pivotal in
during the course of stage 7. the development of two of the three current pharmaceutical
With appropriate care and life support, patients can treatment modalities for Alzheimer’s. His rating scales and
survive in this final substage of AD for a period of years. descriptions of the nature and course of Alzheimer’s are widely
With the advent of the seventh stage of AD, certain used throughout the world.
winter 2008 www.ALZinfo.org 13
Food and Nutrition By Jennifer Sellers

5 Healthy Food Resolutions


for the New Year
Adopting healthy eating habits can help preserve memory.

A
healthy, well-balanced diet may salmon and eating it with whole grain
help protect against Alzheim- crackers is easy, quick and a great way
er’s, and is also recommended to get omega-3 fatty acids in your diet.
for those who already have the disease. Add a fruit and a glass of milk, and it’s
The New Year is a great time to update a meal.”
your diet, but many people find it dif- So, how much fish should you have?
ficult to adopt new habits. If you’re re- The American Heart Association rec-
luctant about making food resolutions, ommends two servings a week. In the
you should know that a complete over- study mentioned above, participants
haul of your lifestyle isn’t necessary. reduced their risk of stroke and mem-
Small changes add up and can make a ory loss with just one serving a week.
big difference in your health and that So start off with at least one serving a
of your loved one. week and look for ways you can have
fish more often. Eating fish everyday is
Making Changes Incorporate More Fish into Your not recommended because of the risk
New Year’s resolutions are notorious- Diet of exposure to too much mercury.
ly unsuccessful. This is often because Fish is an important part of a mem-
people try to make too many changes ory-preserving diet. The omega-3 fatty
all it once. If you’ve failed at resolu- acids in fish are known to be heart
tions in the past, that’s actually a good friendly, but research suggests they
thing—you already know what doesn’t may benefit the brain as well. A recent
work for you. “The way you start a new study found that fish such as tuna and
habit is up to you,” says Ruth Frech- salmon might help protect the brain
man, registered dietitian and spokes- against stroke and memory loss. In ad-
person for the American Dietetic As- dition, the omega-3s found mainly in
sociation. “Some people like to jump oily fish may also help ease agitation
right in, but most people need to take and depression in those who have Al-
baby steps. zheimer’s disease. Check the nutrition
“It’s human nature to not want to label on canned fish to see how much
change,” she continues. “The key to fat is present. The more, the better.
success in keeping food resolutions is to Despite the benefits of consuming
remember to do it. It helps to post notes fish, many people object to the cost
on your refrigerator or a desk as remind- and availability of it. But eating more
ers to eat a fruit for snack.” fish doesn’t have to be costly or diffi-
With this advice in mind, what are the cult. In fact, incorporating more fish
best changes to make? If you’re looking into your diet is easy, says Frechman.
for dietary changes that will improve “Eat a tuna fish sandwich for lunch one
your brain health, try these five food day and have salmon for dinner one
resolutions: day. Opening a can or pouch of tuna or
14 Preserving Your Memory winter 2008
Indulge Your Sweet Tooth With Fruit
Not only can fruit help reduce your
waistline; it can help protect your
brain, too.
Eating more fruit is one of the sim-
plest dietary changes you can make.
“Grabbing fruit, such as bananas or
apples, for a snack is super easy and an
excellent way to get vitamins, minerals
and fiber,” says Frechman. “ A small
can of fruit or dried fruit travel well.
Adding frozen blueberries to plain yo-
gurt is very quick, easy, and healthy.”
But remember, too much fruit adds Making wise choices in your diet can help
calories and can cause weight gain. protect the brain.
Here are some of the fruits that re-
searchers believe may improve your
brain health:
• Apples: It has been suggested that a and lard, try replacing them with ol- dian cuisine contains an immune-
pigment in apples called quercetin ive oil or canola oil. When preparing a boosting substance called turmeric.
might help prevent memory decline. salad, add olive oil or flaxseed oil to the Indian healers have long used curry to
• Blueberries: Antioxidants and com- salad dressing. treat a range of ailments. Now, mod-
pounds called flavonoids are found You can also find omega-3s in wal- ern studies suggest that it might break
in blueberries. It has been suggested nuts, organic eggs, and the meat of up beta-amyloid plaques in the brain.
that some of these may help preserve grass-fed lamb, chicken and cows. • Mediterranean: The Mediterranean
memory. diet has many components that are
• Fruit Juices: In one study, older men and Go Green ... and Orange brain-friendly. These include fish, ol-
women who drank fruit (or vegetable) When it comes to eating vegetables, ive oil, fruits, vegetables and whole-
juices more than three times a week filling your plate with a variety of colors grains. The Mediterranean diet has
were 76 percent less likely to develop may be your best bet. Green leafy veg- been incorporated in the cooking
Alzheimer’s disease than those who etables are thought to help reduce Al- styles of many different regions. In
drank juices less than once a week. zheimer’s risk. Research found that old- fact, it’s the basis for certain types of
er women who ate a lot of spinach and Italian, French, Greek and Middle
broccoli did better on memory tests than Eastern cuisine. ■
those who ate less of the vegetables.
One of the great things about veg-
etables is that they’re easy to prepare.
Spinach can be used in a salad or on a
sandwich. Broccoli can be steamed in
the microwave and ready in a few min-
utes. And instead of using white pota-
toes for baking or mashing, try using
sweet potatoes.

Spice up Your Meals With Variety


Cook with Good Fats Trying new cuisines can not only get
Omega-3 fatty acids aren’t just found you out of a food rut, but some culi-
in fish. They can also be found in olive nary styles use ingredients that may
oil, canola oil and flaxseed oil. A simple actually help decrease your Alzheimer’s
way to get more of these “good” fats in risk. If you’re looking for a change, try
your diet is to use them in food prepa- these food styles:
ration. If you tend to cook with butter • Indian: Curry, a popular spice in In-
winter 2008 www.ALZinfo.org 15
Caregivers in Training
By Jennifer Sellers

A nationwide community college initiative helps provide a caregiving education to


professional caregivers and family caregivers alike.

A
fter high school, you probably went on to receive more Health and Education (SCSHE) to create the Community
specialized training at college or on the job. Perhaps College Caregiver Training Initiative, which aims to
throughout the course of your life you have taken night increase the number of qualified caregivers throughout
classes or Internet courses, the country by providing
improving your knowledge them with education and
and expertise on anything resources through their local
from 19th century American community colleges.
poetry to industrial electrical According to the American
construction. But most of us Association for Community
never receive preparation for Colleges, 60 percent of
the one role we most assuredly all new registered nurses
will take on at some point in receive a degree from a
our lives: caregiving. Sure, two-year institution. This
many people navigate their way makes community colleges
through parenthood, marriage a prime training ground for
and eldercare, picking up professional caregivers.
resources and advice along the “Since a lot of community
way, but the right education colleges already have nursing
could make caregiving much At Arkansas State University—Mountain programs, many could easily
easier—especially for those Home, Nancy Svehla, L, in green scrubs, add a class on professional
caring for an older loved one provides instruction. caregiving,” points out
with a chronic disease like Megan McIntyre, director of
Alzheimer’s. communications for ILC-USA.
“Community colleges play a vital role in educating in-
Community College Caregiver home caregivers as our country faces an increasing need for
Training Initiative quality, accessible, affordable care,” says Robert N. Butler,
Statistics show a growing need for home-based caregivers. MD, president and CEO of the ILC-USA and co-director of
Approximately 20 percent of American adults who need The Caregiving Project for Older Americans.
caregiving assistance aren’t able to find help, whether paid To put this theory in action, ILC-USA offers annual
or voluntary, says the International Longevity Center- grants to community colleges to either establish a caregiving
USA (ILC-USA). This trend will likely continue as Baby program or to enhance an existing one. These grants are
Boomers age—leading to a larger number of older adults funded by MetLife Foundation. The initiative is in its
and a reduced number of health care professionals. ILC-USA second year, and so far, the response has been excellent, says
predicts that the need for in-home caregivers will double McIntyre. “We were surprised at how large the response was,
by 2050. However, the available pool of family caregivers is but it was encouraging” she says.
shrinking, and at the same time, the caregiving profession “The tremendous response and high quality of the
is experiencing a severe and worsening shortage of paid submitted proposals underlies the demand for well-trained
caregivers, says ILC-USA. home caregivers,” says Sibyl Jacobson, president of MetLife
To defer a caregiving crisis, the number of trained Foundation. “The award winners exemplify that community
professional and family caregivers must increase over the colleges can be a leading force in improving the nation’s
coming years. Community colleges may turn out to be ideal caregiving workforce,”
recruitment centers for both types of caregiver. Through “The number of high-quality training programs submitted
the Caregiving Project for Older Americans, ILC-USA was exceptional,” agrees Kenneth Knapp, PhD, project
has collaborated with the Schmieding Center for Senior manager for the Caregiving Project and senior research
16 Preserving Your Memory winter 2008
analyst at the ILC-USA. “We hope this initiative continues can be a class for family caregivers, or maybe just a conference
to highlight the important role community colleges can play once a semester.
in training our nation’s professional and family caregivers.” “While we think it’s absolutely important to train
professional caregivers, the purpose of the grant is to make
A Diversity of Communities and Programs sure family caregivers are educated as well. So much of the
The grants are available to community colleges caregiver responsibilities with older adults fall on family
nationwide. “We members, whether
try to make it it’s a spouse or
geographically grown children and
variable throughout grandchildren. That
the country so that trend is growing, so
we can reach a lot that’s something we
of communities,” want to focus on.”
says McIntyre.
Community colleges A Caregiving
that have already Program at
won grants for the Work
initiative represent a One of the
diverse collection of beneficiaries of a
communities across 2008 grant was the
the country—serving Elder Stay at Home
both urban and rural in Hawaii program
communities as well as offered at the Kapuna
minority populations. Elder Education
“One of the Center of Kapiolani
community colleges The first MetLife Foundation-supported class at Community College
that received a grant Kapiolani Community College’s Kupuna (Elderly) in Honolulu, Hawaii.
last year serves a large Education Center. Toni Hathaway, MSW, and Penny Hill, The Kapuna Elder
Native American Education Center
RN, are course instructors for this 25-hour training.
population, so is the only official
they tailored their gerontology program
curriculum to make sure it was culturally relevant to the in the University of Hawaii community college system;
population they’re teaching,” says McIntyre. however, Hawaii has one of the fastest growing senior
In addition to the regional accessibility of the grants, the populations in the United States, says Cullen T. Hayashida,
guidelines are simple. There are very few parameters the PhD, long-term care coordinator at the Kapuna Education
colleges have to follow when submitting a grant proposal. “We Center
try not to restrict what they’re applying for because we like After receiving its grant, Kapiolani Community College
creative and new ideas,” says McIntyre. “It’s a wide variety, sent two of its faculty to Arkansas to receive further training
what the colleges have used the grant money for. Some might SCSHE. “Our Elder Stay at Home Program is based on their
do something like video-conferencing their caregiving training groundbreaking work,” says Dr. Hayashida.
classes to their satellite branches in rural areas.” While there, Kapiolani faculty received training on
“The colleges selected represent the variety of innovative teaching a three-tiered home care program, which include
training programs that promise to produce quality in-home Elder Pal, Personal Care Assistant and Home Care Assistant.
caregivers,” says Dr. Butler. “All three levels are oriented toward home and community-
based care,” says Dr. Hayashida. “They are distinct from the
A Family Component current state and Medicare CNA (certified nursing assistant)
There is one feature required in each grant proposal: The training that emphasizes institutional nursing home care.”
proposed program must address family caregivers. “It can In addition, the 150 hours required for CNA training is
be a program primarily for training professional caregivers, resulting in a shortage of trained home care workers, says Dr.
but it must have a family component; that’s really the only Hayashida. “Less training is needed for those who may require
specification we have,” says McIntyre. “We’re very strict in lighter care at less cost. There has been nothing in the state to
saying that some part of their grant has to be family-based. It fulfill that training requirement. The shorter, tiered training
winter 2008 www.ALZinfo.org 17
Grant Winners—Community Colleges
Across the Nation
Colleges that have been awarded grants through the
Community College Caregiver Initiative serve com-
munities across America—from the East Coast to the
Midwest to the Hawaiian Islands. Here is a list of the
2007 and 2008 grant winners:
• Anne Arundel Community College, Arnold,
Md., 2007
• Arkansas State University Mountain Home,
The class at Kapiolani Community College Mountain Home, Ark., 2007
takes a break from instruction. • Brookhaven College, Farmers Branch, Texas,
2008
• Capital Community College, Hartford, Conn.,
approach is attractive to many home care workers who can 2008
start working after the first level and then continue to take • Cincinnati State Technical and Community
the next level of training if desired. We are finding that many College, Cincinnati, Ohio, 2008
family caregivers are also interested in this training approach.” • Community College of Vermont, Waterbury, Vt.,

In November 2008, Kapiolani Community College 2007
offered its first class in the Elder Stay at Home course. • GateWay Community College, Phoenix, Ariz.,
The first-level (Elder Pal) course contained students who 2008
represented a full spectrum of Hawaii’s multi-ethnic culture. • Gateway Technical College, Kenosha, Wis.,
A second-level class will be offered in early 2009. “At least 2007
half expect to take the next level,” confirms Dr. Hayashida. • Harford Community College, Bel Air, Md., 2008
“The feedback from the students has been very positive.” • Houston Community College-Southeast,
Houston, Texas, 2007
About International Longevity Center-USA • Johnson County Community College, Overland
and MetLife Foundation Park, Kan., 2008
• Kapiolani Community College, Honolulu,
International Longevity Center-USA Hawaii, 2008
International Longevity Center-USA (ILC-USA) was • Lackawanna College, Scranton, Pa., 2007
founded in 1990 by world-renowned gerontologist and • Madison Area Technical College, Madison,
Pulitzer Prize winner Robert N. Butler, MD. It is the first Wis., 2008
nonprofit, nonpartisan, international research, policy and • Neosho County Community College, Chanute,
education organization formed to educate individuals on Kan., 2007
how to live longer and better, and to advise society on how • North Central Texas College, Gainesville,
to maximize the benefits of today’s age boom. To learn more Texas, 2007
about International Longevity Center-USA, visit their website • Peninsula College, Port Angeles, Wash., 2007
at www.ilcusa.org. • Piedmont Virginia Community College,
Charlottesville, Va., 2007
MetLife Foundation • Portland Community College, Portland, Ore.,
MetLife Foundation was established in 1976 by MetLife 2007
to carry on its long-standing tradition of corporate • Rogue Community College, Grants Pass, Ore.,
contributions and community involvement. Since then, the 2007
Foundation has been involved in a variety of aging-related • Southeastern Community College, Whiteville,
initiatives, including those that address issues of Alzheimer’s N.C., 2008.
disease caregiving, intergenerational activities, mental fitness, • Southwestern Oregon Community College,
health and wellness programs, and civic involvement. To Coos Bay, Ore., 2008
learn more about the work of the Foundation, visit MetLife’s • Tulsa Community College, Tulsa, Okla., 2008
website at www.metlife.org. ■ • Union County College, Cranford, N.J., 2008

18 Preserving Your Memory winter 2008


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Caregiver Voices Written by Gary Joseph Le Blanc,
Florida

Keeping It Simple
Staying Afloat in the Sea of Forgetfulness

R
ound-the-clock living and taking
care of an Alzheimer’s patient for
the past few years have unearthed
several absolutes for being a caregiver.
At the very top of the list is routine—a
steady, run-of-the-mill lifestyle. In fact,
routine is probably good for everybody.
It might be boring, but if you don’t have
any short-term memory, it will be your
greatest friend. A habitual life will ease
most nervousness and frustration. Now I
have no medical degree, but speak from
pure experience. Eight years ago my fa-
ther was diagnosed with Alzheimer’s.
I try to serve his breakfast and din-
ner the same time every day; I even use a
particular plate for his pills every morn-
ing and evening. When I don’t, we have
a problem: “These aren’t the pills I took Gary Joseph Le Blanc (R) and his father.
yesterday.” Even the silverware has to be
kept in a simple pattern. A pasta dish that
doesn’t require a knife will still have one he never eats in the morning, or claim didn’t recognize someone. Once in the
placed next to it. that he already took his pills. Sounds mi- emergency room a doctor was asking
The same applies to clothing. There’s no nor, but these things have a way of snow- him basic questions to check his lucid-
reason for him to make too many choices. balling together, and by day’s end, he’s a ity. One of the questions happened to
Three to four outfits will keep things un- mess. So am I. be, “Do you know who the president
complicated. An enchanting young wom- One day he had two different doc- is?” He looked at me, then around the
an once told him how good he looked in tor visits scheduled. On the way home room, and said absolutely nothing. The
red. Well, red it was; for almost a whole he kept insisting I was going the wrong doctor left the room and closed the cur-
year the man wore only red shirts. Funny way, while continuously opening the tain. Dad promptly quipped, “This guy
how certain thoughts cling to the inside door as I was driving. calls himself a doctor and he doesn’t
of his head. I had to buy four red shirts The easier life is for your patient, the even know who the president is.” We
just so laundry wouldn’t have to be done more pleasant yours will be. I’m just could hear the doctor laughing on the
every day. Red pants were completely out speaking from my own experience. other side of that thin curtain wall.
of the question, thank goodness! You’ll still have to step outside and Neighbors might wonder why you’re
What most people don’t realize is that kick some dirt around now and then, beating up your lawn. Ignore them.
a casual trip to the doctor will have him just to deal with the frustrations. Re- Just keep telling yourself, “It’s not his
confused for days. Every two months in peating yourself 50 times a day, an- fault”—because it’s not. Keep these be-
the same waiting room he’ll ask if we’ve swering the same questions over and loved victims’ lives as uncomplicated as
been there before. By the time we’re home over, and listening to multiple excuses possible. Love them and be their most
you can’t convince him he ever went. The tends to wear the fabric a bit thin. forbearing friend and enjoy them for as
next day he’s completely out of sequence. There will always be an explanation long as you still can.
He’ll wake up earlier than usual, swear for something he forgot or why he It will be well worth it in the long run.
20 Preserving Your Memory winter 2008
Use It or Lose It
ble for him. I believe that by blocking everything else out he’s
able to evade most frustrations and jitteriness for a short period
of time. Here, I must tell you that if he wasn’t playing solitaire

T
hree thousand days. Eight years. That’s how long my I’d be constantly worrying about what else he might be into, so
father has been fighting his way through the demean- this safety bubble covers quite a bit of time and space. Sanctuary
ing stages of Alzheimer’s. for him, and a little breather for me.
He’s done extremely well for himself, probably better than I’ve seen this man look up at me with an expression of plain
most. I truly believe it’s because of setting the ground rule fear, suddenly without a clue of where he was or how he got
making sure that he has a tranquil routine life, keeping con- there, cloaked in panic.
fusion as far away as possible. On a final trip to visit relatives in Canada, he lifted my consid-
Indeed, routine will be your best friend if you lose access of erable body off the motel bed by my shirt collar at 3 a.m. Quite
your short-term memory. Limiting bedrock choices and deci- honestly, I never would have believed that he had that much
sion-making will help minimize most nervousness and frustra- strength. Screaming, he demanded to know where he was.
tion. Again, this holds true even in setting a schedule for meals Though my intentions came deep from within my heart, I had
or walks daily. I can’t stress enough how important routine is in violated everything I’d preached. Taking him out of his own
pacifying people who have memory-impaired lives. environment so he could see his loved ones while he still knew
Now, I have no medical education. Mine comes strictly who they were, I had paved a road to hell with good intentions.
from sharing the woes and burdens of this day-by-day, year- You have to consider what’s best for them, and the bottom line
by-year journey where you need to use the love in your heart is, “routine.”
as your guide. Next morning I picked up a $2 deck of cards that ushered
As I dealt with the devastating changes this cruel disease him back into his safety zone. If the counting of numbers and
causes, I believe one of the most merciless junctures was watch- matching the red and black suits give him security, he can play
ing Dad lose control of his attention span. Initially, I noticed all the solitaire he wants.
things such as reading the first three pages of a book several What’s more important is that he’s continuously exercising his
times or losing patience during television programs. Progres- mind. I honestly believe that keeping his mind busy is the only
sion of the disease was characterized by obnoxious verbal and reason he knows who I am today.
hand gestures toward the boob tube and high decibel com- Crossword puzzles, jigsaw puzzles, checkers, favorite hobbies,
ments such as, “You call this acting?” It was just a few years anything memory-impaired patients enjoy will help both of you.
back that he favored mystery shows, such as Murder She Wrote Don’t try to push something new. It will only create confusion.
or Hercule Poirot. Now relentless progression of Alzheimer’s If your patient loves to knit, let them make a scarf a half-mile
has extinguished all short-term memory and he’s convinced long. You’ll find out there is something about repetition that
they’re all a bunch of idiots. Once a commercial breaks, he seems calming.
forever loses track of who murdered whom. No one will ever convince me that keeping their minds oc-
Fortunately, we live by Florida’s Gulf Coast, where the Tampa cupied could do any harm. It’s even better if they feel they’re
Bay Rays have finally turned into a winning baseball team. He’s being useful.
been so much better while watching sports. The top of the screen We owned a used bookstore where he and I have worked side-
holds an attention-getting scoreboard. He will still ask me 30 to by-side for more than 15 years. I still bring him to work with
50 times who’s playing or who’s winning, but the air traffic flow me in the afternoons. This is usually the hardest part of my day.
of four-letter words flying around our living room has dimin- There’s a table set up where he prices hundreds of books in a
ished considerably. couple of hours. They all have to be re-priced the next morning,
During his earlier stages I’d leave the Gameshow Channel on but that’s okay. The worst is constantly keeping a vigorous eye
most of the day. Even now that he has regressed to seldom know- on him. I feel my afternoon just came to a complete stop when
ing the answers, I’m convinced those shows have kept his upper he comes through the door. The only work being done is seeing
gears shifting, if nothing more. For instance, if he said the an- over him, but it makes him feel needed, more importantly, still
swer was blue and they said it was white, next came, “I told you a man. I’ll do whatever it takes for him to hold onto that feeling.
it was white!” Poor Regis Philbin was quickly dispatched with, It is well worth the brief disruption.
“This game is rigged!” Through all those years I’ve watched my father be demeaned
Have you ever heard the expression “Use it or lose it”? Well, on a daily basis by this pilfering, barbaric disease with real loath-
that’s where I’m heading with this. Dad still plays five to six ing. It’s a long, slow and painful ride for any caregiver. Hopefully
hours of solitaire on a daily basis. my words will help you take some of the bumps out along the
Some time back during a moment of clarity, he explained to way. ■
me how, when he plays cards, it creates some kind of safety bub-
winter 2008 www.ALZinfo.org 21
Ask the Experts For this issue, our questions are being answered by Dr. Dede Bonner, a.k.a. the “Question
Doctor,” and author of The 10 Best Questions™ for Living with Alzheimer’s.

Question: My father was just 2. What stage is his Alzheimer’s dis-


diagnosed with Alzheimer’s ease and how rapidly is he declin-
disease. Does he now need to see ing?
a specialist? If so, what questions 3. Do you feel comfortable telling your
do we need to ask on our first husband about your depression and
visit? other feelings?
4. Do you have a history of depression
Dr. Bonner answers: When prior to having to deal with his Al-
a person is initially diagnosed zheimer’s?
with Alzheimer’s disease, the most 5. Can you find another satisfying out-
important first question to ask is, let for expressing your feelings, like
“How sure are you that this is really close family members or friends?
Alzheimer’s disease?” This question 6. Are you interested in joining a sup-
may be the most important question port group for the caregivers of Al-
you ever ask in your life. zheimer’s patients?
Many people never think to ques- 7. Is there an Alzheimer’s support
tion a diagnosis of Alzheimer’s disease. group located near where you live?
If your doctor tells you it’s Alzheimer’s 8. Can you leave your husband alone
disease, it probably is. But the impor- or make arrangements to attend
tance of this Best Question can’t be em- support group meetings?
phasized enough. No matter what, be 9. Would an online support group be
sure to ask this question. An estimated Dr. Dede Bonner more desirable for you? (generally
10 percent of all Alzheimer’s diagno- less travel and time involved)
ses are incorrect even with today’s im- cialist and what to ask when seeking a 10. Do you prefer to share your feelings
proved diagnostic tests. second opinion. in the privacy of a trained therapist
You have every right to know as much or counselor who will focus just on
as possible about how this diagnosis was your needs rather than in a support
made. Keep in mind that you aren’t Question: My husband and I have group discussion where most of the
necessarily challenging your doctor’s been married for many years, and others are also talking?
personal wisdom or credentials. A good we’ve always been close—like
doctor will expect and welcome your best friends. But now that he has
questions, especially since total certainty Alzheimer’s, I feel more like his Question: My mom’s Alzheimer’s
with Alzheimer’s diagnoses is impossible mother than his partner. I love him disease seems to be progressing.
until an after-death autopsy. and I’d do anything for him, but I worry about her because she
The Question Doctor advises that this change in our relationship lives out of state, and my father,
you phrase this question, “How sure…” has made me quite depressed. who has declining health, isn’t
rather than “Are you sure…” When you Is this just a stage for spousal able to properly care for her. How
ask a yes/no question like “Are you sure?” caregivers? Should I see a doctor can I ensure she is monitored and
you don’t get as much information from about my depression … or can I cared for? Should I try to move
your doctor as if you had phrased it more expect it to pass? my parents in with me? Should
open-ended like “How sure?” I place my mom in a nursing
The decision to see a specialist is a Dr. Bonner answers: Your home? I need to know what the
personal one. Keep in mind that a di- decision about how to handle your best options are for long-distance
agnosis made by a general practitioner depression depends in part on your families dealing with Alzheimer’s.
for an early stage of Alzheimer’s is the honest responses to the following:
most uncertain type of diagnosis. My 1. Can your husband still carry on nor- Dr. Bonner answers: In order for
book also includes ways to find a spe- mal conversations most of the time? a long-distance adult son or daughter

22 Preserving Your Memory winter 2008


to know how to handle their failing However, he often heads out on case-by-case decision, while the Ameri-
parent, you first need to ask yourself his own. How do we know when can Academy of Neurologists suggests
several Best Questions. it’s time for him to stop driving? no further driving for people with Al-
A very important preliminary Best I want to make sure it’s earlier zheimer’s at any stage. Seek your doc-
Question is, “How safe are my par- rather than later as I don’t want tor’s advice first to fully understand
ents if they continue to live in their him hurting himself or others. your husband’s mental and physical
home without assistance?” Consider This is a sensitive issue, though. current limitations.
especially home stairs that could cause How should I approach it? Then to assess your husband’s driv-
falls, possible fire hazards, and wheth- ing capability, ask yourself, “Is he in-
er or not your mom wanders or has creasingly nervous behind the wheel?”
other difficult behaviors. Many long and “Is he having frequent close calls
distance children seek the services of in traffic?” Another very re-
an occupational therapist, physical vealing question is, “Does he
therapist, or geriatric care manager get lost in his own neighbor-
to assess and monitor their parents’ hood?”
home situation. When it’s time for the “Big
If you are trying to decide whether Talk” plan it in advance. Let
or not your mom should move in your husband be involved in the
with you, ask yourself, “How will decision to quit or reduce his driv-
this affect my life, finances, fam-
fam ing by asking him Best Questions
ily, and other relationships?” and such as, “Are there other ways you
“What unresolved conflicts are can get around without driving?”
there between me and my moth-- and “Which friends can provide
er?” and “What happens if Mom rides when you need them?”
moves in, but it doesn’t work There are more Best Questions in
out?” my book to assess an elderly person’s
The decision to place a par- driving skills and to ask the driver
ent in a nursing home is often with Alzheimer’s during a family
very painful. Before taking meeting. ■
this big step, consider other
alternatives. Ask yourself, For More Information
“What other sources of sup- Dede Bonner’s book, The 10 Best
port could care for mom?” (adult day Questions™ for Living with Alzheim-
care, home services, visiting nurses, or er’s: The Script You Need to Take Con-
nearby family members) and “Is there Dr. Bonner’s book is available trol of Your Health, is available wher-
a special person I can count on to look from booksellers nationwide. ever books are sold.
after my parents?” (either a paid geri-
atric care manager or a relative). Dr. Bonner answers: It isn’t just Do you have a question you would
Alzheimer’s patients who ultimately like to ask the experts at the Fisher
face driving retirement. It happens Center for Alzheimer’s Research
Question: My husband is in the to everyone. But this doesn’t make Foundation? If so, please call
early stages of Alzheimer’s and it any easier for families with a loved 1-800-ALZINFO, visit ALZinfo.org,
still thinks it’s fine for him to one in denial about his progressing send surface mail to Fisher Center
drive. The idea of him behind Alzheimer’s disease and the need to for Alzheimer’s Research Foundation,
the wheel makes me extremely surrender the car keys. West 46th Street & 12th Avenue,
anxious. Whenever we go Even the experts can’t agree. The Al- New York, NY 10036, or e-mail
somewhere together, I drive. zheimer’s Association recommends a info@alzinfo.org.

winter 2008 www.ALZinfo.org 23


By Jennifer Sellers

Photo: Julia Verderosa

Caregiving, Flu and You


Olympic gold medalist Kristi Yamaguchi wants you to
protect yourself and your family from the flu. If you’re a
caregiver, the need to do so is even more important.
24 Preserving Your Memory winter 2008
Y
ou’ve probably had the flu at least once in your life. Are You a Face of Influenza?
You likely remember the aches, pains, fatigue and To raise awareness about the flu and the importance of
respiratory symptoms that kept you in bed for days. getting vaccinated against it, Yamaguchi joined the Faces
You know the flu is not a gentle virus, but did you know of Influenza campaign. The American Lung Association is
it could be deadly? That’s why a flu shot is a good idea for using Faces of Influenza to educate high-risk groups about
anyone caring for an Alzheimer’s patient. the need for flu vaccinations. The campaign’s website,
Because of the demands of caring for an Alzheimer’s patient’s www.facesofinfluenza.org, features portraits of people, both
needs, caregivers are particularly prone to flu outbreaks. (See famous and not-so-famous, who represent high-risk groups.
sidebar, “Caregiver Stress Could Lead to Flu Susceptibility.”) If you’re a caregiver of a person with Alzheimer’s disease,
Studies have shown that caregivers who are under chronic both of you are likely faces of influenza, meaning you are
(prolonged) stress may have a diminished immune response, more likely to develop complications from the flu and you’re
which can potentially make them slower to heal after injury likely to spread the virus to other people who are at risk. Being
and more susceptible to common infections such as the flu. over the age of 50 or having a chronic medical condition puts
Even if you have had and recovered from the flu in the you at risk. And if you’re in contact with someone else who is
past, it’s important that you get a flu shot each fall or over the age of 50 and has a chronic medical condition, you
winter to prevent yourself from getting it again. By doing could be putting them at risk as well. That’s why flu shots for
so you can help protect yourself and the people you come caregivers and their loved ones are very important.
into contact with—including your family.
Kristi Yamaguchi, Olympic gold medalist and winner Older Americans and the Flu
of ABC’s Dancing with the Stars competition, knows the Ninety percent of flu deaths and more than half of
importance of flu protection—not just for herself, but hospitalizations due to flu occur in people 65 years and older.
also for her entire family. She has made it her mission to In addition, only 30 percent of people over the age of 65 get
educate caregivers on the importance of flu shots. “When vaccinated against flu. That’s why the CDC is encouraging
my daughter Emma was born, my doctor gave me a flu everyone in this age group to get flu shots every year.
vaccination before I left the hospital to help prevent If you’re a Baby Boomer, you’re not exempt. It is in your
spreading this serious disease to my newborn infant,” she 50s and early 60s that you are likely to start developing
says. “Since then, I make sure we all get vaccinated every chronic illnesses, which puts you at higher risk for flu
year. This includes my husband, my two daughters and complications.
even the grandparents in our family.” Alzheimer’s caregivers are usually spouses or adult children,
therefore most Alzheimer’s caregivers are over the age of 50
Understanding the Flu and should get an annual flu shot, says the CDC. “Flu is not
This time of year, the flu and the common cold are to be taken lightly,” says Anne Schuchat, MD, director of the
lumped together a lot—cold and flu season, cold and flu National Center for Immunization and Respiratory Diseases
medicines, cold and flu symptoms—but the flu and the at the CDC. “People who do not get the flu vaccine are taking
common cold are not the same. While both illnesses are two risks: First, they risk a potentially serious case of the flu.
caused by viruses (the flu is caused by the contagious And second, if they get sick, they risk passing it to family …
influenza virus), the symptoms and complications of the flu Vaccination is the single best way to protect yourself and the
are much more severe. In fact, 36,000 people die from the people you love from influenza.”
flu each year, according to the the U.S. Centers for Disease
Control and Prevention (CDC). Find a Flu Clinic Near You
Symptoms of the flu aren’t pleasant—they include high fever,
headache, muscle aches throughout the entire body, extreme You may be able to get a flu shot at your
fatigue, dry cough, runny or stuffy nose, sore throat and, as doctor’s office, through your employer, at
anyone who has ever had the flu will attest, general misery. your local pharmacy or any number of places.
Occasionally someone with the flu will experience To easily find a flu clinic near you, visit www.
complications, which can include pneumonia, dehydration flucliniclocator.org. This website, created by
and worsening of health problems such as asthma, heart the American Lung Association, will allow
disease and diabetes. Those in high-risk groups, such as you to search for flu clinics by date and zip
senior citizens and people with compromised immune code. It also has functions that allow you to
systems, are most likely to experience complications. Each set a flu shot reminder for yourself and send
year, more than 200,000 Americans are hospitalized with the finder to your friends and family.
flu complications, says the CDC.
winter 2008 www.ALZinfo.org 25
Protecting your loved ones is at the heart of Yamaguchi’s
message: “As a mother, I realize my whole family needs to be Caregiver Stress Could Lead
immunized, and that’s a responsibility that I take seriously.” to Flu Susceptibility
In managing the health and day-to-day needs of your
Sources: The U.S. Centers for Disease Control and Prevention, loved one, you must not overlook your own health and
www.cdc.gov; The American Lung Association, www.lungusa. well-being. Your health can suffer from the stress of
org; The Fisher Center for Alzheimer’s Research Foundation, round-the-clock responsibilities and the emotional toll
www.ALZinfo.org. of witnessing the disease’s devastating progression in a
loved one. Be mindful of your physical, psychological
6 Flu Shot Myths Debunked and spiritual needs. By taking care of yourself, you’ll be
able to better care for your loved one.
Myth #1: The flu vaccine increases To combat keep their immune systems strong,
Alzheimer’s risk. caregivers need to learn how to manage stress and find
Truth: The theory that flu shots can increase a person’s risk ways to relieve the tremendous burden of constant
of developing Alzheimer’s disease has been discredited. In care for a loved one. Don’t become isolated; enlist
fact, several mainstream studies, including one published support from other caregivers, a caregiver support
in a 2001 issue of Canadian Medical Journal, and another group, family and/or friends so you can carve out time
published in a 2003 issue of JAMA, the Journal of the American to pursue activities that you enjoy and maintain social
Medical Association, have suggested that flu shots and other connections.
vaccinations may lead to a reduced risk of Alzheimer’s disease, Many communities or long-term-care facilities offer
as well as an increase in overall better health. respite programs that enable caregivers to take needed
breaks from caregiving while knowing their loved one is
Myth #2: You can catch the flu from getting well taken care of. Such services may be available from
the vaccine. home healthcare agencies, assisted-living facilities or
Truth: The injectable flu vaccine doesn’t contain the live nursing homes. Enrolling the person with Alzheimer’s in
influenza virus, so it’s impossible to “catch” the flu in even an appropriate adult day care program can also provide a
a mild form from getting a flu shot. There can be some side necessary period of respite for the caregiver.
effects to the flu shot, such as a headache, low-grade fever,
and soreness, swelling or itching at the injection site. These
side effects are usually mild and only last for a few days. to a “stomach flu,” they are most likely referring to viral
In addition, they don’t occur in everyone who gets a flu gastroenteritis, which is not the illness commonly known as
shot. The flu shot might not be right for you, however, if “the flu.” The flu shot does not protect against this virus or
you have a severe allergy to eggs or if you have had a severe any viruses other than the influenza virus.
allergic reaction to a flu shot in the past.
Myth #5: You shouldn’t get a flu shot if
Myth #3: Flu shots are only given in the fall. you’re sick.
Truth: Flu shots can be given any time from October Truth: Minor illnesses, even those accompanied by a fever,
through March. Most years, the flu season doesn’t begin should not prevent you from getting a flu shot. In fact, if you
until January, and doesn’t peak until February or March. are frequently ill due to chronic health problems, a suppressed
The earlier you can get your flu shot, the better, but if it’s immune system or exposure to others who are frequently sick,
winter and you haven’t gotten your vaccination yet, it’s not that is all the more reason for you to get a flu shot. Otherwise,
too late. Just remember, it takes your body about two weeks if you get the flu, your risk for complications could be higher
after the shot to build immunity to the influenza virus. The than that of someone in good health.
influenza virus differs from year to year, so it’s important to
get a vaccination annually. Myth #6: The flu shot protects you against
the avian flu, better known as the “bird flu.”
Myth #4: The stomach flu is a type of Truth: The flu shot does not protect against the bird flu. In
influenza virus, and the flu shot can protect addition, it should be noted that, currently, the standard in-
the body against it, too. fluenza virus poses a much greater risk to the health of Ameri-
Truth: The flu is primarily a respiratory illness, although cans than the minute risk of bird flu. The influenza virus is
it can cause additional complications. When people refer also easily preventable through the annual flu vaccine. ■

26 Preserving Your Memory winter 2008


Healthy Recipes These recipes offer healthy, creative alternatives to traditional New Year’s foods.

Curried Mustard Greens & Garbanzo Beans with Sweet Potatoes


Preparation Time: 30 minutes Number of Servings: 4 Cups of Fruits and Vegetables Per Person: 1

Ingredients
2 medium sweet potatoes peeled and sliced thin 1/4 tsp turmeric
1 medium onion cut in half and sliced thin 2 cups chopped and rinsed mustard greens
2 medium cloves garlic, sliced 1 15 oz can sodium-free diced tomatoes
1/2 cup + 1 Tbsp low-sodium chicken or low-sodium 1 15 oz can garbanzo beans, drained
vegetable broth 2 Tbsp extra virgin olive oil
1/2 tsp curry powder salt and white pepper to taste

Directions
Steam peeled and sliced sweet potatoes for approximately 5-8 minutes. While steaming potatoes, slice onion
and garlic. Heat 1 Tbsp broth in 12-inch skillet. Sauté onion in broth over medium heat for about 4-5 minutes
stirring frequently, until translucent. Add garlic, curry powder, turmeric, and mustard greens. Cook, stirring
occasionally until mustard greens are wilted, about 5 minutes. Add garbanzo beans, diced tomatoes, salt and
pepper. Cook for another 5 minutes. Mash sweet potatoes with olive oil, salt and pepper. If you need to thin
potatoes, add a little more broth. Serve mustard greens with mashed sweet potatoes.

Nutrition Facts per Serving


Calories: 300; Total Fat: 8g; Saturated Fat: 1g; Trans Fat: 0g; Cholesterol: 0mg; Sodium: 600mg; Total Carbohydrate:
50g; Dietary Fiber: 9g; Sugars: 8g; Protein: 8g; Vitamin A: 260%; Vitamin C: 50%; Calcium: 8%; Iron: 10%

Black-eyed Pea Salad


Preparation Time: 9 hours, 15 minutes Number of Servings: 6 Cups of Fruits and Vegetables Per Person: 1/2

Ingredients
Salad 1/3 cup red onion rings 1/4 cup water
1-1/2 cup water 4 cups leaf lettuce 1 tsp olive oil
1 medium onion, cut in half 1/4 tsp salt
1/2 tsp salt Dressing 1/4 tsp black pepper
1/2 tsp cayenne pepper 1/2 cup chopped red bell pepper 1 garlic clove, minced
16 oz package frozen black-eyed peas 3 Tbsp chopped parsley 1/8 tsp hot sauce
1/2 cup red wine vinegar
Directions
Salad
Combine water, onion, salt, and cayenne pepper, in a medium saucepan; bring to a boil. Add peas and return to
a boil Cover, reduce heat, and simmer 40-45 minutes or until peas are tender. Remove and discard onion; drain
well. Rinse with cold water, and drain again. Transfer to a medium bowl; set aside. Pour dressing over peas,
tossing gently to coat. Cover and refrigerate 8 hours, stirring occasionally. Add red onion just before serving.
Serve over lettuce leaves on individual plates.

Dressing
To prepare dressing combine all ingredients and mix until well combined.

Nutrition Facts per Serving


Calories: 140; Total Fat: 2g; Saturated Fat: 0g; Trans Fat: 0g; Cholesterol: 0mg; Sodium: 320mg; Total Carbohydrate:
24g; Dietary Fiber: 5g; Sugars: 2g; Protein: 8g; Vitamin A: 30%; Vitamin C: 40%; Calcium: 6%; Iron: 10%

Find more healthy recipes at www.fruitsandveggiesmatter.gov.

winter 2008 www.ALZinfo.org 27


Fisher Center Research

Breakthrough in Alzheimer’s and


Parkinson’s Research
seem to know exactly what types of cells fight schizophrenia and depression.
to attack. While destroying one type of The TRAP tool advances the speed
cell, a disease will inexplicably spare a at which researchers can yield results
seemingly identical group of neighbors. and should fundamentally change
What makes cells vulnerable or not may biochemical studies of the brain. “We can
depend largely on these translational look at a thousand genes instead of one at
profiles. For this reason, scientists have a time, so things should clear a thousand
struggled to analyze the subtle molecular times faster,” says Dr. Greengard, who
differences among the hundreds of won the Nobel Prize in Physiology or
specialized cell types that are tangled Medicine in 2000 for research into how
together in tissues like the brain. neurons communicate.
The new TRAP procedure solves a This new technique will help accelerate
problem that has been a fundamental scientific research into discovering the
barrier to a deeper understanding of subtle molecular differences amongst
the brain and how neurological diseases the hundreds of specialized cell types.
attack it. The true breakthrough lies in A deeper understanding of body cell
its ability to distinguish the profile of mechanisms will help researchers
any cell type in any tissue in the body. investigate the causes of Alzheimer’s and
Dr. Myriam Heiman Its usefulness is not just limited to brain Parkinson’s diseases. ■
cells, meaning it has

I
n the November 14, 2008, issue of far-reaching research
the journal Cell, researchers at The applications—cancer,
Michael Stern Parkinson’s Research heart disease, diabetes,
Center at The Rockefeller University as well as many others.
report a breakthrough in cellular analysis Dr. Paul Greengard,
that solves a problem that has perplexed the director of the
neurological research for decades. Michael Stern Center
Lead author Myriam Heiman and her where Myriam
colleagues have developed a method to Heiman is a Research
reveal the kinds and amounts of proteins Associate, says about
different cells produce, what biologists half of the research in
call the cell’s translational profile. The his lab now employs
technique involves isolating the genetic the new technique to
messages that govern protein production study the biochemical
in different cell types. The new bases of Alzheimer’s, Dr. Greengard, pictured above, is also the
method, “translating ribosome affinity Parkinson’s and director of the Fisher Center for Alzheimer’s
purification” (TRAP), can identify all other diseases. It is
Disease Research at The Rockefeller
the genetic messages that give a cell type also being applied to
its unique identity, including perhaps its the still-mysterious
University. A complete PDF of the TRAP
susceptibility to disease. ways in which finding from Cell can be found on
Like skilled assassins, many diseases psychoactive drugs www.parkinsoninfo.org.
28 Preserving Your Memory winter 2008
Living with
Alzheimer’s Disease
Products That Make Life Easier, Simpler, and Safer

Every 72 seconds, someone in the United States is diagnosed with Alzheimer’s disease. There
are now more than 5 million Americans living with the disease. What is not widely known—even
by some physicians—is that there are products available that are made especially to help make
Alzheimer’s patients’ lives better with the disease, and, in some cases, to help them remain living at
home longer and safer.

The Alzheimer’s Store is dedicated to providing unique products and information for those caring
for someone with Alzheimer’s disease. Every product in the store has been carefully selected to
make living with Alzheimer’s disease as easy as possible. The store also provides a rating system
for products that tells potential buyers whether a particular product is for the early, middle, or late
stages of the disease. For example:

❖ A clock that will automatically remind an Alzheimer’s sufferer of the day and
date. This easy-to-read, battery-operated wall clock displays the day of the
week and date, and automatically changes at midnight.

❖ A medication dispenser that prevents accidental double-dosing. This


automatic medication dispenser beeps at the right time, provides the right
meds, and is lockable so no more pills can be taken until the next dose
time. This dispenser should not be used by a person with Alzheimer’s
without supervision, but it can be very useful for people with milder forms of
memory or cognitive impairment.

❖ A telephone that allows the user to push the picture of the person they want
to call. For those who may be a little forgetful or who have difficulty seeing
the numbers, this phone is a blessing.

With over 200 products that address various activities of daily living and caregiver challenges,
the Alzheimer’s Store is dedicated to finding and providing products for people with Alzheimer’s
disease and those caring for them.

For more information and many more helpful products,


go to www.alzstore.com or call (800) 752-3238.
Fitness By Michelle Porter Tiernan

Boost Energy and Bring Calm


with the Healing Power of Yoga
T
hree women in their 60s and 70s Bray is leading a 30-minute yoga ses- energy and relief. Adapted to meet your
recline on their backs on yoga sion on the DVD Yoga for Caregivers. needs as a senior caregiver, yoga prac-
mats with their eyes closed and She models simple yoga poses that are tice can help recharge your body, mind
their hands turned palms up. Certified specifically designed for caregivers to re- and spirit.
yoga instructor Helena Bray begins lieve stress and improve physical health.
savasana, the final relaxation. Her voice As a caregiver of a loved one with Al- Feel Younger
is quiet and soothing. zheimer’s disease, you may find yourself Light exercise like yoga is easier on
“Imagine there is a river gently flowing facing many days full of frustration, fa- the joints and can be a good choice
by you, and a leaf floats along the river,” tigue and even depression. When you’re for seniors. Yoga gradually builds flex-
Bray says softly. “By the time you notice an older adult, the emotional strain of ibility and strength, improves concen-
the leaf, it is already gone. Let it go—in caregiving—combined with your own tration and increases energy, says the
and out of sight, in and out of mind. If stiff joints, limited mobility or fitful American Yoga Association. Studies
thoughts come into your mind, treat them sleep—can leave you feeling drained. show that practicing yoga on a regular
as the leaf on the river. Let them go.” Yoga is a simple exercise that offers basis may help lower blood pressure,

The stretching and breathing


exercises of yoga helps
improve mobility and flexibility,
while reducing stress and
stiffness.

30 Preserving Your Memory winter 2008


reduce anxiety and depression, and im- ferent schools of yoga. Two of the most The American Yoga Association’s
prove sleep. recognized are Hatha Yoga, physical Easy Does It® Yoga is a nationally rec-
Yoga does not need to be a very intense movements and postures combined ognized program developed in the
movement to be a beneficial exercise, says with breathing techniques, and Raja 1960s by Alice Christensen. Designed
Frank Iszak, founder of San Diego-based Yoga or the “royal road,” which incor- specifically for older adults just starting
Silver Age Yoga and a yoga expert with 15 porates exercise and breathing with to exercise or adults with physical limi-
years of teaching experience. meditation and study. tations due to age, illness or inactivity,
“Seniors often address insur- the six-week program includes
mountable issues like depression basic yoga poses, breathing and
and other psychological issues,” meditation.
Iszak says. “In most cases, those Easy Does It Yoga is a gen-
who participate in yoga classes tler form of yoga that adapts
find tremendous improvement.” traditional yoga techniques to
Yoga taps into emotions that make them safe and simple for
we all share, Iszak says. “Un- those who face physical limi-
derstanding, patience and love tations. Although it is not an
are deeply seated human quali- intense program, the American
ties that yoga brings to the Yoga Association says the pro-
surface. As caregivers, we can gram is just as effective as more
reach this—it’s at the heart of strenuous fitness programs for
what we do.” getting and staying in shape.
All exercises in the program
Reach Inner Harmony are gentle bends, twists and
The word yoga means to lifts that can be performed on
join or yoke together. A series the floor or in a chair, bed or
of connected movements com- wheelchair. Movements are
bined with carefully paced performed with specific breath-
breathing, yoga brings the ing patterns that strengthen
body and the mind together the respiratory and circulatory
as one. systems. Postures such as the
Yoga is an uplifting exer- Gentle Full Bend, the Easy
cise for the spirit, but it is not Sun Pose and the Elbow Twist
necessarily connected with target weaker spots and im-
religion. Although yoga tech- Yoga can provide caregivers with an prove flexibility.
niques have been adopted by important tool for preserving good health.
many religions throughout the Give Yoga a Try
world, yoga itself is merely an If you would like to get
exercise that can be used to manage Stay in Shape started in yoga, the American Yoga As-
stress, learn to relax and become more As a senior caregiver, you should sociation recommends finding a quali-
self-aware. choose a form of yoga specific to your fied teacher or purchasing a good book
According to the American Yoga As- needs. Yoga can be practiced by most or DVD. Try contacting adult educa-
sociation, the practice of yoga is an an- adults of any age or physical condition, tion programs, family YMCAs, com-
cient exercise. Stone carvings have been but there are particular programs de- munity centers or local dance studios
discovered of figures in yoga poses that signed for seniors. to locate a yoga class that caters to your
are at least 5,000 years old. The tradition Silver Age Yoga Community Out- requirements as a caregiver and as an
has passed down from teacher to student reach helped produce the DVD Yoga older adult.
through word-of-mouth and practical for Caregivers. The program offers free, Iszak recommends finding a yoga
demonstration. Formal techniques that weekly yoga classes at senior centers class that is oriented to seniors and
are currently known as yoga evolved throughout the San Diego area. Silver sensitive to your needs. “Yoga should
from the collective experience of many Age Yoga also teaches special skills for not be patronizing,” he says. “You need
individuals over thousands of years. yoga instructors to deal with the chal- genuine love—kindness and a spiritual
Today, there are more than 100 dif- lenges faced by older adults. connection.” ■
winter 2008 www.ALZinfo.org 31
Long-term Planning By Bernard A. Krooks, Esq.

Third-Party Special Needs Trusts:


Peace of Mind for Caregivers
W
e are all aware of the impor- cially, he can’t seem to hold onto money provided for him for the rest of his life;
tance of getting our family’s when it comes his way. Emily, who is not otherwise, he might have to go into a
financial and legal affairs married, has given up her job to help as- nursing home.
in order. For family Without appropriate
members of individu- estate planning, John
als with Alzheimer’s will inherit from Sally
disease, the impor- or Emily in the event ei-
tance of doing advance ther of them dies before
planning is magnified. him. Since John is not
There are a lot of is- able to manage finan-
sues facing family mem- cial assets, this would
bers when a relative has most likely require the
Alzheimer’s disease. court appointment of a
One of the items that is guardian for John, un-
most often overlooked less John has executed
is what happens if the advance directives such
caregiver dies before the as a power of attorney
family member with appointing agents oth-
Alzheimer’s disease. er than Sally or Emily.
This is certainly un- Such a guardian would
derstandable, given the have to manage John’s
tremendous emotional assets and account to
strains and other issues the court each year.
that must be confronted In addition, the as-
when a family member A third-party sets that John receives
is ill. While there is no special needs trust may preclude him from
perfect replacement for a may be the ideal obtaining certain types
caregiver’s love and care, of governmental assis-
arrangement for
some planning methods tance benefits without
some families.
are better than others. the assets being spent
down on the cost of his
A Typical Situation care. The area of gov-
Consider this family’s situation: sist Sally in taking care of John, who has ernmental benefit programs is complex,
John and Sally have a modest estate: Alzheimer’s disease. Although Charlie as John may be entitled to one or more
a home, some money in the bank and is not currently involved in John’s care, programs and the requirements are dif-
retirement accounts from when they he has promised to help out if anything ferent for each type of program. For ex-
were both working. They also have two happens to Sally or Emily. ample, John may be on Medicaid and
adult children: Charlie and Emily. Em- Caring for John is very important his inheritance would disqualify him
ily is independent and doing well finan- to Emily and Sally. They understand from those benefits until the money is
cially. Charlie, who is married, has been that John is not able to live indepen- spent down since Medicaid is a means-
bouncing around from job to job and dently or support himself. He will need tested program, which means there are
has never really found himself. Finan- a home, income and a support system strict asset and income requirements
32 Preserving Your Memory winter 2008
that all Medicaid beneficiaries must the death of the caregiver. By setting (IRAs), care must be taken regarding
comply with. up and funding a third-party special the timing and distribution of such
Based on this scenario, Emily and needs trust; the caregivers will ensure funds to maximize tax savings. When
Sally are considering es- an IRA beneficiary has
tate planning. They are medical needs such as
thinking of leaving all John does, even more
their assets to the survi- care must be taken
vor of the two of them, to ensure that the tax
or, to Charlie since he benefits are maximized
has promised to take while maintaining ac-
care of John if anything cess to much-needed
happens to Emily and government-financed
Sally. health care programs.
Is this a good solution? Certain types of
trusts require the ben-
A Better Approach eficiary to take at least
Actually, this solution the required minimum
has serious problems. No distribution from the
assets are legally protect
protect- IRA each year and
ed for John and he may A little careful planning for caregiving needs then pass that amount
live for several years after can help everyone breathe a little easier. directly to the ben-
his caregivers pass away. eficiary. In general, this
Moreover, although well- type of trust may make
intentioned, Charlie may not live up to the highest quality of life for John. sense from a tax perspective; however,
his commitment. This could happen trust assets paid out directly to the ben-
should Charlie have financial problems, Drafting a Successful SNT eficiary will disqualify the beneficiary
become ill himself, get divorced or die. The SNT would be designed to hold from participation in most means-test-
John’s security is imperiled. John’s inheritance. It needs to be care- ed programs. Other types of trusts al-
A good solution is the creation of a fully drafted so that the assets in the low the trustee to accumulate income
third-party special needs trust (also trust can be used to enhance John’s (including the minimum distributions
known as a supplemental needs trust) lifestyle and not cause him to lose his taken by the trustee) within the trust.
for John. This trust, drafted specifi- needs-based benefits. In most of these While this type of trust may preserve
cally for this purpose, can be created means-tested programs, the benefi- government benefits, it may not be the
as part of Emily or Sally’s testamentary ciary’s receipt of funds will terminate most tax-efficient way to take distribu-
distribution plan when they die. A plan the beneficiary’s participation in the tions from the IRA, depending on your
with such a trust does not rely on the program. SNTs are designed to allow individual circumstances.
moral commitments of others to be suc- the beneficiary to maintain eligibility Of course, there is no one perfect
cessful. The term “third-party” special for most means-tested programs, while solution that works just right for every
needs trust (SNT) means that the assets still allowing the trustee to access trust family. However, it is important to re-
used to fund the trust do not belong to funds to pay for goods and services that member that a plan be put in place to
John; they are assets of a “third-party.” enhance the quality of the beneficiary’s provide care for your relative with Al-
In this case the assets used to fund the life. For example, the state Medicaid zheimer’s disease in the event you pass
trust may be assets of Emily and Sally. system may pay very little in the way away before your loved one. ■
In many cases, caregivers such as Emily of private duty nurses; however, the
and Sally do not have sufficient assets funds in the SNT can be used for this Bernard A. Krooks, J.D., CPA, LL.M (in
to meet their relative’s needs after they purpose. Also, the funds in the SNT taxation), CELA is immediate past president
die since more formal arrangements can be used to take John on vacations and founding member of the N.Y. chapter
with paid caregivers need to be made. or other quality-of-life excursions. Nei- of the National Academy of Elder Law
One way of solving this problem is to ther of these distributions will reduce Attorneys and a nationally known and
create a third-party SNT and fund it John’s needs-based benefits. widely quoted expert on elder law. For more
with life insurance that will pay the life Since a portion of Sally’s estate is information, visit the firm’s website at www.
insurance proceeds to the SNT upon held in individual retirement accounts littmankrooks.com.
winter 2008 www.ALZinfo.org 33
Keeping Your Mind Sharp
Brain-Boosting Puzzles
“Use it or lose it.” The message is simple. If you don’t use your
muscles, they will no longer be as effective as they should be. Of
course, the brain is not a muscle; however, it has recently come
to light that “mental workouts,” such as solving crosswords and
other puzzles, can help ward off Alzheimer’s. In these pages, we
offer a variety of different types of puzzles that will work out your
various skills involving memory, deduction, and letter manipula-
tion, and, we hope, also provide you with a ton of fun!
(Answers on page 37)

MAT C H THESE DROPLINE


Match These Droplines
Can you
Can
Can you match
you
created it?
created
created
match
it?
it?
Match These
match each
each fictional
each fictional place
fictional place to
place to the
to the writer
the writer who
writer who
who Take the
Take
Take the letters
the letters
and distribute
and
and distribute them
distribute
Droplines
letters inin the
in
them
the top
the
them in in
top half
top
in the
the
half of
half
the blanks
blanks
of each
of
blanks of
each column
each column below
column
of the
of the bottom
the
below
below
bottom half
bottom half
half
1. _____
1.
1. _____ Lilliput
_____ Lilliput
Can you match each fictionala.
Lilliput a.place
a. William
to the
William
William Faulkner
writer who
Faulkner
Faulkner so that
so
so that
that the
Takethe
the lettersinread
the letters
letters
letters read
the top
read from
from
from halfleft
of to
left
left to right
each
to right
column
right spell
below
spell
spell out aaa
out
out
2. _____ created
Oceania it? b. A.A. Milne short
short quotation
andquotation
distribute them
quotation from
from H.L.
in H.L.
the
H.L. Mencken.
blanks The black
of the bottom
Mencken. The black
half
black
2. _____
2. _____ Oceania
Oceania b. A.A.
b. A.A. Milne
Milne short
so that the
from
letters read from
Mencken.
left to right
The
spell out a
3. _____ 1. _____ Lilliput
_____ Emerald
Emerald City c. James
Jamesa. William
MichenerFaulkner squares
squares are are the
are the spaces
the spaces between
spaces between
between words. words.
words. One One letter
One letter
letter
3.
3. _____ Emerald City
2. _____ Oceania
City c.
c. James Michener
b. A.A. Milne
Michener squares
hasshort quotation
been dropped
dropped in infrom
placeH.L. Mencken.
to start
start off.The black
you off.
4. _____
_____ Jabberwocky
Jabberwocky Wood Wood d. Lewis
Lewis Carroll
Carroll has been dropped in place to start you off.
4. _____ Jabberwocky Wood d. Lewis Carroll
has been place to you
4. 3. _____ Emerald City d. c. James Michener squares are the spaces between words. One letter
5. _____
5. _____ Middle-earth
_____ Middle-earth
Middle-earth
4. _____ Jabberwocky Wood e. e. Jonathan
e. Jonathan
Jonathan Swift
Swift
d. Lewis Carroll
has been dropped in place to start you off.
HAAH HD D III III A
AE EAAA AU UAAEEDDL LL A
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5. Swift
6. _____
6. _____ Yoknapatawpha
_____ Yoknapatawpha
Yoknapatawpha County
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5. _____ Middle-earth f.f. J.M.
J.M.e.Barrie
J.M. Barrie
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Jonathan Swift
H
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12. _____ 11. _____
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12. _____ Utopia
l.l.l. C.S.
C.S. Lewis
C.S. Lewisl. C.S. Lewis

Here’s aaaHere’s
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list of two-word
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titles of
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of TV
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series each number.
eachnumber.
number.
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list of two-word titles
titles of ’60s TV series —— one series
series for
for each number.
The The
letters
The letters
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two the
two words two
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correct order, but
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they
but they overlap.
overlap.
they overlap.
overlap. All Allyou
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All you
you
you
have to have
to do
do toto do to
find thefind the terms
terms is separate
is separate
separate the letters.
the letters.
letters.
have
have to do to
to find
find the
the terms
terms is
is separate the
the letters.
Example: Example:
CAB BSE CAEN
SE BSE Y EN—Y BEN— BEN CASEYCASEY
Example:
Example: CA
CA B SE ENY
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BEN CASEY
CASEY
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•VISIT US AT KAPPAPUZZLES.COM•

34 Preserving Your Memory winter 2008


B R A IN - B OOS T I NG CRO S S W O RDS

We have provided two crosswords here to sharpen your puzzle


skills. Start with the one on the left, which is the easier puzzle. (Answers on page 37)
In this one we have provided solving aids,
We have provided two crosswords here to sharpen your puzzle
of words
skills. Start in multi-word
with the clues.
one on the left, whichThe puzzle
is the
such
easieron
as the number
the right is a
puzzle. Men of Rank
Across 42. “Untouchable” 21. High mountain
In this medium-level
of words
one we have provided
in multi-word
have
solving
puzzle and
clues. The
been eliminated.
theaids,
Thepuzzle
such of
number as words
secondonpuzzle
the number
the right
in the answers
is a a thematic
is also 1. Volvo Ness Men of Rank
22. Gone by
medium-level
puzzle:puzzle and“Men
the title the number
of Rank”of words in the
is a hint. answers
Have
Across
fun testing your 42. “Untouchable” 21. High mountain
competitor 45. Role for Harry 23. The, in Berlin
have been eliminated.
knowledge whileThe
doingsecond puzzlethat’s
something is also a thematic
good for you! 1. Volvo Ness 22. Gone by
puzzle: the title “Men of Rank” is a hint. Have fun testing your 5. Martini liquor Morgan 24. Solitary number
competitor 45. Role for Harry 23. The, in Berlin
knowledge 1while 2doing 3something
4 that’s good for5 you! 6 7 8 8. Against (prefix) 49. Boats 25. Shade tree
5. Martini liquor Morgan 24. Solitary number
12. Barcelona
8. Against (prefix) 49. Boats like Noah’s
25. Shade tree 26. “ Magic”
1 2 3 4 5 6 7 8
9 10 11 beverage 50. “ whillikers!” 27. Mama deer
12. Barcelona like Noah’s 26. “ Magic”
9 10 11 beverage 13. Comedienne
50. “ whillikers!” onMama deer28. “Snakes
51. Take27.
12 13
13. ComedienneCharlotte 51. Take on employees
28. “Snakes Plane”
12 13
14 15 16 Charlotte14. Reverse, for one 52. Navy chow
employees Plane” 30. Boca
14 15 16 14. Reverse,15.
forRole
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Navy chow 53. Cruet30.liquid
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17 18 19
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to 31. From Z
17 18 19
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Carl 31. From
speak) Z32. “Bewitched”
20 21 22 23 24
20 21 22 23 24
18. Astronomer Carl Tim
19. Comic speak) 32. “Bewitched” baby
25 26 27 19. Comic Tim20. Illustrations Down baby 36. Coarse
25 26 27 20. Illustrations Down 1. Scand.
21. Ballantine 36.airline
Coarse 37. Ward off
28 29 30 31 32 21.
33 Ballantine 1. Scand. airline 37. Ward off
28 29 30 31 32 33 product 2. Middle 38. Union
product 2. Middle 38. Union
34 35 36 22. “Lad: ” 3. Subtle glow group (abbr.)
34 35 36 22. “Lad: ” 3. Subtle glow group (abbr.)
25. City rails 4. Plane’s 39. Shell game
37 38
25. City rails 4. Plane’s 39. Shell game
37 38 26. Bride’s answer
26. Bride’s answer compartment
compartment
40. Tiny opening
40. Tiny opening
39 40 29. Role for29. Role for5.George
George Lee’s foe 5. Lee’s41.
foeSorts 41. Sorts
39 40
C. Scott C. Scott6. Author Fleming 6. Author
43. Fleming 43. Elevator pioneer
Elevator pioneer
33. Raw mineral
33. Raw mineral 7. Tennis
7. Tennis necessity Hatcher or44.
44. necessity Hatcher or Garr
Garr
Across Across 34. Sing 34. Sing along
along 10.action
10. Football Football34.
action
24-hour34. 24-hour8. Nimble 8. Nimble 46. Id’s partner46. Id’s partner
1. Self-defense (2 wds.) (2 wds.) 11. Birds’ 11.
1. Self-defense Birds’ abodes
abodes teller (abbr.)teller (abbr.) 9. Singer
9. Singer Carter 47.Carter
Luau memento47. Luau memento
methodmethod 36. Slangy 36. Slangy refusal
refusal 15. Ark man
15. Ark man 35. On a 35.
cruise On a cruise
10. Accept 10. Accept
48. Go on a 48. Go on a
36. Sporty Pontiac
36. Sporty 11. in Nutrientpension
Nutrient 11.
Pontiac in (abbr.)pension (abbr.)
5. Lad’s5.partner 37. Copland
Lad’s partner and
37. Copland 18.
andWorship18. Worship of the ’60s
of the ’60sred meat red meat
9. “Pequod”
9. “Pequod” Spelling Spelling
captain captain from from 37. Josh 37. Josh 16. Lobe’s locale 16. Lobe’s locale
10. Park
10. Park bird 38.
bird the
38. Red the Red
20. Skater20.
Henie 39. Politician
Skater Henie 39.Agnew 17. Light
Politician Agnewwood17. Light wood
12. Bakery items 39. Charles
12. Bakery items 39. Charles 21. Person21.
from
Person from1 2 3
1
4
2 3
5 6
4
7
5
8
6
9
7
10 11
8 9 10 11
13. Broad street Gibson’s domain Columbus
13. Broad street Gibson’s domain Columbus 12 13 14
12 13 14
14. Martin 40. Smell terrible 22. Baseball “judge”
14. Martin 40. Smell terrible 22. Baseball “judge”
15 16 17
and Charlie 24. First game of 15 16 17
and Charlie 24. First game of 18 19
16. Misters Down the season 18 19
16. Misters
17. Home run
Down
1. Sharp thrusts
the season
27. Centuries and
20 21
20 21
17. Home run 1. Sharp thrusts 27. Centuries and
22 23 24 25 26 27 28
hitter Sammy 2. “No way, centuries
22 23 24 25 26 27 28
19. Tenth hitter Sammy Jose!” 2. “No way,29. Winter won-
(hyph.) centuries 29 30 31 32
29 30 31 32
19. Tenth
month (abbr.) Jose!” (hyph.)derland
3. Copenhagen 29.need
Winter won-33 34 35

month (abbr.)native3. Copenhagen derland need 33 34 35


20. John Philip 31. Environment- 36 37 38

20.warnings
23. Golf native
John Philip4. Become fixated alist Al31. Environment-
39 40 41 36 42 437
3 438
4

23. Golf
25. Electrical unitwarnings
5. Actress4.Ullmann
Become fixated alist Al
32. Mayberry lad 45 39 40 41
46 47 42 48 43 44

26. Pile25. Electrical unit


6. Time periods 33. Vampire’s
5. Actress Ullmann target
32. Mayberry lad
49 45 50 46 41
5 7 48

28. Pinches
26. Pile 7. Prom 6.
attendee 35. Parts of
Time periods ft.Vampire’s target
33. 52 53 54
49 50 51
30. Beaver State
28. Pinches 8. Origin7. Prom attendee 35. Parts of ft. 52 53 54
30. Beaver State 8. Origin

winter 2008 www.ALZinfo.org 35


BRAI N - B O O ST IN G PU Z Z L ES
HIDDE N-M E S SAG E WORD- FIND
Hidden-Message Word-Find
Hidden-Message Word-Find
All the words in the list, which are about exercise and physical activity, can be found in the letter grid reading across, up and
down, and diagonally. When you have found them all, read the leftover letters to discover an apt quote from Robert M. Hutchins.
All the words in the list, which are about exercise and physical activity, can be found in the letter grid reading across, up and
You to
down, and diagonally. When you have found them all, read the leftover letters arediscover
lookingan
forapt
a 58-letter phrase.
quote from Robert M. Hutchins.
BADMINTON SKATING S W H E N I F S E B E S L G
You are looking for a 58-letter phrase.
BADMINTON SKATING T W
S L G
H N
E I
N EI O
F N
S A
E C
B P
E SI W N
L G
BOWLING SOCCER
H
T K
L E
G E
N XI C
E E
O D
N O
A U
C T
P RI W
A N
I
BOWLING SOCCER
CANOEING SOFTBALL
G
H L
K C
E L
E C
X G
C M
E D T
O I
U R
T S
R L
A TI
CANOEING SOFTBALL
DANCING SWIMMING I
G L I
C E
L L
C I M
G N I
D N
T G
I E
R L
S K
L A
T
DANCING
GOLF
SWIMMING
TAE KWAN DO
EI A
L RI EI N
L AI S
N I J
N U
G A
E S
L I
K K
A

GOLF TAE KWAN DO


W
E B
A T
R TI W L
N A B
S EI M
J B
U D
A SI NI S
K
HANDBALL TENNIS
G D
W B O
T K F G
T W L E
B Y
E T M
M B M
D DI G
N S
HANDBALL TENNIS
JOGGING TREADMILL N
G N
D E O
O K W L
F G N
E F
Y E
T A M
M I N
D U
G SI
JOGGING
JUMPING ROPE
TREADMILL
VOLLEYBALL I
N A
N N
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O I L O
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A LI W
N H
U NI

JUMPING ROPE VOLLEYBALL TI H


A E
N F
T EI S
L E G
O I G
T L L I H
W S N
LIFTING WEIGHTS WALKING
F
T I
H N
E J
F U
E M
S P
E I
G N G
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LIFTING WEIGHTS WALKING
PILATES
FI G
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SIT-UPS LI G N
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G A
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L A W
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SIT-UPS
Sudoku
L G N I C N A D S A W J A Y

Sudoku
SUDOKU
To complete the puzzle below, fill in the squares so that each digit 1 through 9 will appear exactly once in
each row, in each column, and in each enclosed nine-unit block.
To complete the puzzle below, fill in the squares so that each digit 1 through 9 will appear exactly once in
each row, in each column, and in each enclosed nine-unit block.
3 4 5
3 5 4 2 8 5
5 4
2 8 8 3
6 3
4 9 8 5 3
9
6 3 9 6
5
7
9 6 1 4
6
2 7 5 6 7
1 4
2 5 6 4
7 1
6 6 4 2 1 9
6 2 9

•VISIT US AT KAPPAPUZZLES.COM•
36 Preserving Your Memory winter 2008
PUZZLE ANSWERS

Match
MatchThese
These Crossword
Crossword1 1 Crossword
Crossword2 2
1e,1e,
2g,2g,
3k,3k,
4d,4d,
5i,5i,
6a,6a,
7l,7l,
8c,8c,
9f,9f,
10b, 11j, J JU UD DO O L LA AS SS S S SA AA AB B G GI IN N A AN NT TI I
10b, 11j, A AG GU UA A R RA AE E G GE EA AR R
12h.
12h. A AH HA AB B P P I IG GE EO ON N
S SE ER RG GE EA AN NT TB BI IL LK KO O
B BU UN NS S A AV VE EN NU UE E
S SA AG GA AN N A AL LL LE EN N
S SH HE EE EN NS S S S I I R RS S A AR RT T A AL LE E
S SO OS SA A O OC CT T A AD DO OG G E EL LS S I ID DO O
Droplines
Droplines S SO OU US SA A F FO OR RE ES S G GE EN NE ER RA AL LP PA AT TT TO ON N
It Itis isthe
thedull
dullman
manwho
whois isalways
alwayssure,
sure, O OH HM M H HE EA AP P O OR RE E A AT TM M A AS SE EA A
andand thethe
sure man
sure who
man is is
who always
alwaysdull.
dull. N N I I P PS S O OR RE EG GO ON N
G GT TO O R RI IB B
S SP PI IR RO O E EL LI IO OT T
J JO OI I N N I I N N N NO OP PE E C CO OL LO ON NE EL LP PO OT TT TE ER R
A AA AR RO ON NS S E ER R I I C C A AR RK KS S G GE EE E H HI IR RE E
N NE EWWS S R RE EE EK K M ME ES SS S O OI IL L A AS SI IT T
Leapfrog
Leapfrog
1.1.Medical
Word-Find
Word-Find Sudoku
Sudoku
MedicalCenter; Center;2.2.PeytonPeytonPlace;
Place;3.3.
McHale’s
McHale’sNavy; Navy;4.4.Burke’sBurke’sLaw; Law;5.5.
S SW WH
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HE EN NI IF FS SE EB BE ES SL LG G 338844117799552266
Petticoat GN NI IE EO ON NA AC CP PI IW WN N
PetticoatJunction; Junction;6.6.Perry PerryMason;
Mason;7.7. H HK KE EE EX XC CE ED DO OU UT TR RA AI I 665577223388449911
GGi l il li lgiagna’ns’ sI sIlsalnadn;d ;8 .8 .MM
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Impossible;
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Daniel Boone.
Boone.
G GL LC CL LC CG GM
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winter 2008 www.ALZinfo.org 37


Medicinal Laughter

Agnes
We are happy to continue to share with you the indomitable Agnes —
also sometimes known as “Wellness Woman” — the delightful cartoon
creation of artist Tony Cochran. Win, lose, or draw, Agnes faces life’s
challenges with spirit, humor, and a never-give-up attitude.

38 Preserving Your Memory winter 2008


Jenny Thompson. Eight Years Old. Big Sister. Avid Reader.
Awesome Flute Player. Alzheimer’s Sufferer.

Because Jenny’s grandmother has Alzheimer’s, Jenny suffers.


Her whole family does. Gramma doesn’t know Jenny anymore.
And that hurts. Caring for Gramma takes its toll on Jenny’s Mom.
And Dad. And the family finances.

But there is hope. At the Fisher Center for Alzheimer's Research, our team
of international scientists, led by Nobel laureate Dr. Paul Greengard,
is rapidly closing in on the cure. And you can help.

For more information or to donate (94¢ of every dollar we raise goes directly
to our research labs), please visit ALZinfo.org or call 1-800-ALZ-INFO.

Because the devastation of Alzheimer’s doesn’t stop with the person afflicted.

WORKING TO MAKE ALZHEIMER’S NOTHING BUT A MEMORY. FOR EVERYONE.


Donate now for the cure. ALZINFO.ORG 1-800-ALZ-INFO

Zachary & Elizabeth M. Fisher Center


for Alzheimer’s Research Foundation
One Intrepid Square
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New York, NY 10036
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