Memorypreserving your Summer 2008 The Magazine of Health and Hope

10 Outdoor Activities to Enhance Your Loved One’s Summer

Learn about the Benefits of Gardening from Is an Effective HGTV Host Justin Cave Alzheimer’s Treatment at Hand? MetLife Foundation Awards Scientists An Expert Speaks for Research in Alzheimer’s Disease

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Is an Effective Alzheimer’s Treatment at Hand? An Expert Speaks Dr. Paul Greengard, Nobel Prize recipient, answers today’s most pressing questions on the causes and treatments of Alzheimer’s disease. 8

MetLife Foundation Awards Scientists for Research in Alzheimer’s Disease MetLife Foundation honored three scientists who have made significant contributions to the understanding of 14 Alzheimer’s.

10 Outdoor Activities to Enhance Your Loved One’s Summer Discover tips to help preserve memories— and create new ones.

20

Easy Summer Gardening Soothes the Soul Learn about the benefits of gardening from HGTV 26 host Justin Cave. summer 2008 www.ALZinfo.org 3 Contents 5 From the Editor’s Desk Summer is a season for memories. 6 News Briefs Read the latest news on Alzheimer’s disease and brain health. 8 Is an Effective Alzheimer’s West 46th Street & 12th Avenue, New York, NY 10036 Treatment at Hand? 1-800-ALZ-INFO • www.ALZinfo.org An Expert Speaks Michael Stern, Publisher Richard Shortway, Associate Publisher 10 Food and Nutrition Betsey Odell, Editor in Chief Fresh fruits deliver good nutrition and great taste. Alan White, Managing Editor 14 MetLife Foundation Awards William J. Netzer, PhD, Science Editor Jerry Louis, Graphic Designer Scientists for Research in Toby Bilanow, Bernard A. Krooks, Contributing Writers Alzheimer’s Disease

© Copyright 2008 by the Fisher Center for Alzheimer’s Research Foundation. 18 Long-Term Planning No part of this publication may be reproduced or transmitted in any form or by Elder-law expert Bernard A. Krooks discusses long- any means without written permission from the Fisher Center for Alzheimer’s Research Foundation. Articles in this publication are written by professional term planning and the role of the spouse. journalists who strive to present reliable, up-to-date health information. However, personal decisions regarding health, finance, exercise, and other 20 10 Outdoor Activities to Enhance matters should be made only after consultation with the reader’s physician or professional adviser. All editorial rights reserved. Opinions expressed herein are Your Loved One’s Summer 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 23 Fisher Center Research Administration on Aging, Department of Health and Human Services. Grantees undertaking projects under government sponsorship are encouraged to express MicroRNA brings new hope for memory preservation. freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official Administration on Aging policy. 24 Caregiver Voices A daughter shares her thoughts on time spent with her dad. 26 Easy Summer Gardening Soothes the Soul Preserving Your Memory is published by Vitality Communications 28 Ask the Experts 407 Norwalk St., Greensboro, NC 27407 Learn how you and your loved one can stay safe (336) 547-8970 outside this summer. Jennifer Sellers, Managing Editor 30 Fitness Traci Shelton, Senior Art Director Aquatic exercise offers many options for all fitness levels. Kathy White, Account Manager Jan McLean, Creative Director 32 Take Action Lauren Croughan, Editorial Assistant Learn how the government is addressing Alzheimer’s Traci Marsh, Production Director disease—and what you can do to help make a Contributing Writer, Michelle Porter Tiernan difference for Alzheimer’s research. 34 Keeping Your Mind Sharp Cover photo: Josh Wolff Give your brain a workout with these brainteasers. Made possible by a grant from 38 Medicinal Laughter Agnes the Wellness Woman gives her perspective on checkups. A leader in finding an Alzheimer’s cure 4 Preserving Your Memory summer 2008 From the Editor’s Desk A Season for Memories ore than any other season, summer tends to bring back memories from the past. A warm breeze may make it seem M like only yesterday when you were running through sprinklers, eating homemade ice cream, and chasing fireflies. Here at the Fisher Center, we’re working diligently to preserve precious memories like these by searching for a cure and more effective treatments for Alzheimer’s disease. In “MetLife Foundation Awards Scientists for Research in Alzheimer’s Disease,” on page 14 of this issue, you can read about Alzheimer’s advancements being made by some of the world’s top scientists. And our feature story on page 8 asks the question: “Is an Effective Alzheimer’s Treatment at Hand?” Also in this issue, we have plenty of articles that will help you incorporate your favorite things about summer into your life as a caregiver. We’re covering healthy summer fruits; gardening, with Justin Betsey Odell Cave, host of the HGTV show Ground Breakers; and aquatic exercise. And if you’re still looking for more ways to enjoy your summer, we have 10 more suggestions for you on page 20. So, get to reading … And once you finish this issue of Preserving Your Memory, put it down and head outside to enjoy your summer. We hope this season will bring back many warm memories for you—and help you create new ones, too.

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 [email protected] Betsey Odell Editor in Chief

For advertising information, please contact: Betsey Odell Kathy White Fisher Center Foundation Vitality Communications (212) 265-0223 (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. summer 2008 www.ALZinfo.org 5 News Briefs

The Latest News on Alzheimer’s Disease and Brain Health

Retired Supreme Court Justice protein in the brain plaques associated and Alzheimer’s Caregiver with Alzheimer’s disease, damaged Sandra Day O’Connor Recently blood vessels in the brains of the mice. Addressed Congress on The damage took place before plaques Alzheimer’s Impact appeared, but the mice still suffered At a hearing of the U.S. Senate Spe- GINA will prevent employers from memory loss and inflammation in cial Committee on Aging, Sandra Day from discriminating against the brain. Previous studies have shown O’Connor, former Associate Justice of individuals on the basis of that diabetics have a 30 percent to 65 the Supreme Court, gave testimony genetic information. percent higher risk of developing Al- on the financial and emotional burden zheimer’s disease than non-diabetics. Alzheimer’s disease places on Ameri- cans, and urged Congress to aid in the GAO Report on Nursing Home funding of the disease. She referenced Quality of Care Released, the rapidly aging American popula- Senators Call for Action tion as evidence of increasing need to In May, the Government Account- combat the disease. O’Connor was the ability Office (GAO) released a report first woman appointed to the U.S. Su- highlighting quality-of-care deficien- preme Court. She retired in 2006, after that a small molecule known as DAPH cies in nursing homes. In response, 25 years, to care for her husband John, can selectively take apart amyloid fibers, Senators Chuck Grassley (R-Iowa) and who suffers from Alzheimer’s disease. some of which are related to Alzheimer’s Herb Kohl (D-Wis.) recommended an disease. “[DAPH] selectively targets overhaul of nursing home standards, A Cup of Coffee a Day May the areas that hold fibers together, and calling for adequate investigative skills Help the Brain converts fibers to a form that is unable for state surveyors to identify prob- A recent study in the Journal of Neu- to grow,” says the study’s senior author, lems; federal penalties strong enough roinflammation showed that caffeine James Shorter, PhD. The study suggests to achieve accountability and encour- in an amount equivalent to one cup of that it is possible to generate small mol- age compliance; and consumer access coffee a day could protect the blood- ecules that can attack the amyloid fibers to accurate, meaningful, and current brain barrier (BBB) from damage from associated with Alzheimer’s disease. data. “Our legislative reform effort a high-fat diet. BBB leakage often oc- is about securing transparency,” said curs in neurological disorders such as Researchers Explain Link Senator Grassley. “With information, Alzheimer’s disease. This study is one between Diabetes and consumers can make the best choices of several that have suggested caffeine Alzheimer’s Disease for their loved ones.” Senators Grassley intake may help ward off memory loss While medical researches have and Kohl have introduced legislation due to aging and may reduce the risk of known that diabetics have an increased intended to improve the quality of care Alzheimer’s disease. risk of developing Alzheimer’s disease, in nursing homes with more and better they were previously unsure why. Now, information for consumers provided by A Small Molecule Can Take the Salk Institute for Biological Stud- the federal government on the Nursing Apart Alzheimer’s Disease ies has identified a basis for the link. A Home Compare website. To view the Protein Fibers study published in Neurobiology of Ag- report, visit www.gao.gov/new.items/ Research conducted at the University ing examined young, diabetic mice and d08517.pdf. For more information of Pennsylvania School of Medicine and found that the interaction of elevated on the Grassley-Kohl Nursing Home recently recorded in the Proceedings of the glucose levels, a characteristic of diabe- Transparency and Improvement Act, National Academy of Sciences has shown tes, and high levels of beta-amyloid, a contact either Senator’s office. 6 Preserving Your Memory summer 2008 Alzheimer’s Vaccine Study Is in the depression of depressed subjects employers from discriminating against Suspended before their diagnosis of Alzheimer’s. individuals on the basis of genetic in- An Alzheimer’s vaccine that is in de- It was surmised that depression would formation, and it keeps health insur- velopment by the pharmaceutical com- increase if it were a consequence of the ance carriers from denying coverage panies Elan Corp and Wyeth has been dementia; however, an increase was not to healthy individuals who may have a suspended mid-trial so that the com- observed. In addition, the researchers genetic predisposition for developing a panies can determine whether a skin concluded that depression may con- disease such as Alzheimer’s. Opponents lesion (an inflammation of blood ves- tribute to changes in the brain that of the legislation worry that it may lead sels) suffered by a patient in the clinical affect its ability to sustain function to frivolous lawsuits, while many oth- trial was due to the vaccine. The U.S. when pathological changes related to ers believe that the bill should go fur- Food and Drug Administration (FDA) Alzheimer’s occur. ther by enabling personal control over halted the trials, and the companies genetic testing results. are now in talks with health regulators Effectiveness of At-Home to analyze the issues surrounding this Alzheimer’s Testing Is Results from NSAIDs Study potential side effect. The patient was Controversial Announced released from the hospital, and the le- Physicians are questioning a new test Non-steroidal anti-inflammatory sions are healing. This trial is unrelated allowing people to test for Alzheimer’s drugs, commonly referred to as to another Alzheimer’s drug called bap- risk at home. The test purportedly helps NSAIDs, appear to reduce Alzheimer’s ineuzamab, which is in late-trial stage patients identify whether or not they risk, but the study found that not all testing by the companies. have a gene associated with Alzheimer’s NSAIDs worked. The study also con- disease. However, being positive for the cluded that NSAIDs are not yet a rec- Result of Third Phase of gene does not mean a person will go on ommended approach for preventing Testing for Alzheimer’s Drug to develop Alzheimer’s. Doctors fear Alzheimer’s, and there is no data sug- Awaited that the test, which costs approximate- gesting that NSAIDs can effectively Flurizan, an Alzheimer’s drug by ly $400 dollars and requires a saliva fight Alzheimer’s. Researchers say Myriad Genetics, had positive results sample, will create unnecessary anxiety that the possible risk-reduction by in phase II of its clinical trial. Many and emotional suffering in patients. NSAIDs is a small benefit. The find- Alzheimer’s patients in the trial got no Any person, even those who choose ings of this study were published in worse during the two years of testing, direct-to-consumer testing, should dis- Neurology. and some of the patients treated with cuss Alzheimer’s risk factors with their the drug actually seemed to improve. physician. Alzheimer’s Sufferer and Participants with mild-stage Alzheim- Legendary Actor Charlton er’s saw the most improvement. The re- Phase III of Gamma Secretase Heston Passed Away This Spring sults of Myriad’s phase III trial will be Inhibitor Trial Charlton Heston, film star of such announced this summer. If successful, Eli Lilly has begun phase III of the Hollywood classics as The Ten Com- the drug could be approved for use in LY450139 trial, which is studying a mandments, Ben-Hur, and Planet of patients and would be the first example gamma secretase inhibitor for the treat- the Apes, passed away on April 5 after of a drug that actually alters the course ment of early- to mid-stage Alzheimer’s a struggle with Alzheimer’s disease. of Alzheimer’s disease. disease. It is hoped that the death of Heston formally announced his Al- brain cells and other degenerative zheimer’s diagnosis in 2002, helping Depression a Risk Factor changes that occur in Alzheimer’s can give a public face to the disease. In ad- Rather than an Early Sign of be slowed through blocking of gamma dition to his career as an actor, Heston Alzheimer’s secretase. If successful, this inhibitor was known as a political activist—from Scientists have long observed a link could slow or stop progression of Al- his Civil Rights work of the 1960s to between depression in old age and in- zheimer’s. his Second Amendment activism of creased incidence of Alzheimer’s dis- later years. He was also a World War II ease. However, until recently, it was Genetic Information veteran and past-president of the Screen unknown whether depression contrib- Nondiscrimination Act (GINA) Actors Guild. He died at age 84. ■ utes to dementia or is a result of it. A Signed into Law study conducted by Rush University President Bush signed into law a bill Check the Fisher Center website Medical Center may have the answer. that is being hailed by some as a civil (www.ALZinfo.org) often for up-to-date In the study, there were no increases rights victory. The law will prevent and expert-reviewed scientific news. summer 2008 www.ALZinfo.org 7 Is an Effective Alzheimer’s Treatment at Hand? The need for an effective An Expert Speaks treatment to halt or even bout $1 billion is spent each year on medicines reverse the like Aricept, Razadyne, Exelon, and Namenda. memory loss AThese drugs are used primarily to ease symptoms of of Alzheimer’s cognitive loss. In general, improvements are modest. Current is as urgent medications for Alzheimer’s may slow mental decline for a as ever. limited time during the early stages of the disease, but do not stop the eventual downward spiral. Others drugs, such as anti-depressants and anti-psychotics, may be prescribed to ease agitation and aggressive behaviors. However, the need for an effective treatment to halt or even reverse the memory loss of Alzheimer’s is as urgent as ever. So is the need to prevent the disease from taking hold in the first place. The number of cases of Alzheimer’s is expected to triple by the end of this century, as the U.S. population ages, causing proportionally more people to be in their 70s and 80s, when an Alzheimer’s diagnosis grows more likely. course of the disease. We asked Dr. Paul Greengard, A number of experimental drugs and vaccines are in Nobel laureate and medical director of the Fisher Center late-stage testing to determine whether they can halt, for Alzheimer’s Disease Research, to comment on new reverse, or prevent the onset of Alzheimer’s. Unlike existing treatments in the Alzheimer’s pipeline. The work of his treatments, these medicines may actually modify the lab at The Rockefeller University has contributed to an understanding of what goes wrong in the brain in Alzheimer’s disease, as investigators around the globe continue their search to find a cure for an ailment that affects 25 million people worldwide.

Dr. Paul Greengard of the Fisher Center for Alzheimer’s Disease Research comments on new treatments now in development.

PYM: Dr. Greengard, is the attempt to reduce beta- amyloid the most promising approach to developing new, more effective treatments for Alzheimer’s disease?

Dr. Greengard: A majority of scientists involved in Dr. Paul Greengard Alzheimer’s research believe that beta-amyloid is the main

Photo: Josh Wolff pathogenic factor responsible for the degenerative changes that 8 Preserving Your Memory summer 2008 occur in the brain during Alzheimer’s disease. Thus, drugs that PYM: Dr. Greengard, are vaccines that clear beta- lower beta-amyloid levels in the brain are expected to offer the amyloid from the brain a promising approach to treating, most promising treatments. However, Alzheimer’s is a complex and perhaps even curing, Alzheimer’s disease? disease. Treatments that do not target beta-amyloid might also be beneficial and might ultimately be used in combination Dr. Greengard: Vaccines that are designed to clear with anti-amyloid therapies. beta-amyloid are a very exciting line of research. They can be divided into two classes, “active vaccines” and “passive vaccines.” The active vaccines consist of a form of beta-amyloid that is injected into the body. This causes the immune system to produce antibodies that attach to beta-amyloid, causing it to be cleared from the body. An “active” vaccine was tested in patients a few years ago. Unfortunately, the tests had to be stopped because the vaccine caused a small number of patients to experience swelling of the brain. This may have occurred because the vaccine also stimulated the immune system to produce specialized T-cells. Drug companies are working on beta-amyloid vaccines that are designed not to stimulate specialized T-cells, in the hope that side effects such as brain swelling and inflammation can be eliminated. “Passive” vaccines consist of antibodies made in the laboratory that are injected into a patient. The antibodies target beta-amyloid. The vaccine is called “passive” because “Active” and “passive” vaccines are now being when it is injected into the body it does not stimulate the tested in the treatment of Alzheimer’s disease. patient’s immune system to attack beta-amyloid by producing its own antibodies or T-cells. As a result, passive vaccines are not expected to produce the toxic effects that were caused by PYM: When might an Alzheimer’s treatment that stops the first, active vaccine tested a few years ago. Passive vaccines the disease from getting worse become available? Would it are also a very promising approach. A passive beta-amyloid help patients who already have Alzheimer’s disease? vaccine is currently being tested in Alzheimer’s patients in clinical trials that will take several years to complete. Dr. Greengard: A drug designed to slow progression of Alzheimer’s disease, Flurizan (tarenflurbil), has recently PYM: Doctors often recommend a daily aspirin, which completed late-stage testing on large numbers of patients, has anti-inflammatory and blood-thinning properties, for and the results of those tests are anxiously awaited. Smaller people at risk for heart disease. Is taking a non-steroidal anti- scale clinical trials of Flurizan carried out over the last inflammatory drug (NSAID) like aspirin each day a good few years have shown promise. In those trials, the drug idea for someone with Alzheimer’s or at risk for the disease? appeared to slow progression of the disease in many patients, but only the results of the larger trials will be conclusive. Dr. Greengard: Current anti-inflammatory drugs Flurizan reduces formation of a particularly toxic form of have not been shown to be useful for treating Alzheimer’s beta-amyloid, called beta-amyloid 42. In the next few years, disease. There is evidence, however, that long-term use additional drugs that lower either beta-amyloid 42 or total (about 5 years) of some but not all NSAIDs (e.g., ibuprofen beta-amyloid will have been tested in large clinical trials. but not celecoxib) might lower the risk of developing We believe that an effective Alzheimer’s therapy will Alzheimer’s disease. However, these drugs can have involve reducing levels of beta-amyloid. However, it is not dangerous side effects, such as gastrointestinal bleeding known whether patients who already have Alzheimer’s could and ulcers for some people. Nevertheless, there is a lot of improve substantially if the progression of the disease is evidence that inflammation plays an important role in slowed or even stopped. Most likely, those who will benefit Alzheimer’s disease. It is hoped, as our basic knowledge of most from beta-amyloid-lowering drugs will be people in the inflammation and its role in the brain grows, that anti- earliest stages of disease, for whom extensive brain damage inflammatory drugs can be developed to treat or prevent has not yet occurred. Alzheimer’s disease. (continued on page 38) summer 2008 www.ALZinfo.org 9 Food and Nutrition

Fresh Fruits Deliver Good Nutrition, Take advantage of summer’s sweet bounty by indulging in good- Great Taste for-your-brain fruits. lutants.” In fact, studies suggest that regular consumption of fruit juices may reduce the risk of dementia by half!

Fresh Fruits Provide a Rainbow of Benefits The antioxidants in fruit include vita- mins A, C, and E and substances called phytochemicals, which are increasingly being recognized as powerful tools for preventing damage to cells in the body. Vitamins such as those above also are necessary for brain function and proper functioning of the immune system. “Some of these antioxidants might even repair damage that already has occurred if it has not yet become a permanent part of the cell,” notes Karen Collins, MS, RD, a nutritional advisor to the Ameri- can Institute for Cancer Research. Apples contain a powerful anti- oxidant called quercitin, which might Summertime is a great time to lessen the risk of developing dementia. get into the fruit habit. Other healthful fruits are blueberries, pomegranates bananas, and oranges. A new study suggests that the fla- raving something sweet? What “They taste great—that’s number vonoids in blueberries might help people if you could indulge your sweet one,” says Lona Sandon, RD, a national with Alzheimer’s. Research conducted in Ctooth with a mouthwatering spokesperson for the American Dietetic the United Kingdom found that blueber- treat—and it was healthy, too? Association. ries impacted spatial working memory. Everyone knows that eating plenty of Fresh fruits are unbeatable as a snack, While scientists previously assumed that fruit is part of a healthy diet, but research salad ingredient, side dish, or dessert. flavonoid compounds in blueberries had shows it can even help preserve memory. But unlike cookies, candies, and cakes, an effect on memory, this study added Sound too good to be true? Not if you fruits are sweet treats that also have basis to the claim. choose your treats this summer fresh sweet health benefits. Other research has found that the from the farm. The summer bounty at “They’re great sources of vitamins the flavonoid compound of luteolin and di- farmers’ markets, roadside stands, and body needs to be healthy,” notes Sandon. osmin are able to reduce levels of beta- pick-your-own farms starts in June when “Fruits are a good source of water. They amyloid (in the laboratory), which is a strawberries come into season. They’re provide fiber content to keep our gas- component of the plaques that build up followed soon by blueberries, raspberries, trointestinal tracts running smoothly. in the brains of Alzheimer’s sufferers. peaches, and then apples in the fall. And they provide antioxidants that can Researchers also found that one of the The top reason you should eat these prevent damage caused by our body’s targets of the flavonoids is presenilin-1, a succulent fruits? metabolism and by environmental pol- protein that has been genetically linked 10 Preserving Your Memory summer 2008 to Alzheimer’s disease. These particular fla- Does your family make the grill an integral vonoids occur naturally in citrus fruits. part of summer dining? Be creative, Collins And, researchers have found many benefits of suggests, and you can easily add fruit to your phytochemicals, which include the substances plate. Grill some chicken, fish, or meat and that give fruits their brilliant hues. In addition then, before serving, top these simple entrees to the possibility that they may help prevent with a sauce made in your blender with fresh dementia, phytochemicals can block certain fruit or a fruit chutney that you can make in cancer-causing agents and also can block oxi- advance. dation of fats so artery walls stay healthier. For a side dish, slice a peach in half, brush While phytochemicals are mostly found in the with canola oil, top with cinnamon, and add skins of fruits, many of these beneficial substanc- it to the grill, Collins suggests. Or layer a va- es are found in fruit juices as well. But be careful. riety of fruits on a kebab stick, prepare the Sugar, in the form of high fructose corn syrup is same way, and grill. The heat really brings added to many, jacking up their calorie content, out the sweetness of the fruit, says Collins. which can lead to weight gain, another risk fac- “If you’re looking for something cool in the tor for Alzheimer’s disease and other illnesses. evening, try a fruit smoothie instead of ice With such a strong résumé of benefits, fruits cream,” suggests Collins. Made in a blender are getting respect in high places—and a more using fresh fruit, juice, and milk or yogurt, a prominent place at the family table. When the smoothie not only gives you the nutrients of U.S. Department of Agriculture (USDA) issued the fruit but also can have more calcium than its most recent dietary guidelines, it recom- ice cream—and a lot less calories. As health- mended 2 cups of fruit daily for the average per- ful as fruit is, try to avoid too much snacking son consuming a 2,000-calorie diet. That is in on fruit. Remember, fruit does contain calo- addition to 2 1/2 cups of vegetables daily. ries and too many calories, no matter what the source, will cause weight gain. Explore New Ways to Use Fruit Not sure how to include 2 cups of fruit in your Now Is the Time to Start Enjoying Fruit! daily diet? It’s not as hard as you think. Just have Summertime is a great time to get into the fruit as a snack once daily and include at least one fruit habit because of the ready availability fruit with every meal. For example, substitute an of fresh local fruit, which tends to be juicier apple for cookies in your brownbag lunch, and and more flavorful than fruit that has been you’ll save calories while adding nutrients. hauled over a long distance to the super- “Something that simple can really add up,” market. Not only will your tastebuds thank Collins notes. you—your brain will, too! ■

Healthy Recipes

Four-Fruit Salad Preparation Time: 10 minutes Number of Servings: 6 Cups of Fruit Per Person: 1

Ingredients 1 cup seedless grapes 1 large apple, cut into slices 1 cup orange segments 1 large pear, cut into slices

Directions Toss all ingredients together. Serving Suggestions: 1. Serve on lettuce lined plate with scoop of low-fat cottage cheese and lite dressing. 2. Serve in glass dish with scoop of sherbet on top. 3. Serve in bowl topped with yogurt.

summer 2008 www.ALZinfo.org 11 Healthy Recipes

Fig Banana Smoothie Preparation Time: 15 minutes Number of Servings: 4 Cups of Fruit Per Person: 0.75

Ingredients 1 cup chopped dried figs (stems removed) 1 cup 1-inch banana slices 1 cup plain non-fat yogurt 3 cups crushed ice 1 Tbsp. honey mint leaf or berry garnish

Directions Place all ingredients except garnish in a blender (not a food processor), and blend until smooth, approximately 2-3 minutes. Strain liquid and pour into tall, chilled glasses. Add garnish.

Strawbrosia Parfaits Preparation Time: 15 minutes Number of Servings: 6 Cups of Fruit Per Person: 0.50

Ingredients 2 cups sliced strawberries 1 banana, sliced 1 orange, peeled and sliced (or 11 oz can mandarin orange segments) 1 cup cubed pineapple, fresh or canned 1 cup (8 oz carton) non-fat vanilla or lemon yogurt ¼ cup grape nuts 6 mint sprigs

Directions In a bowl mix strawberries, banana, orange, and pineapple. Pour orange juice over fruit and toss. Refrigerate until chilled. To prepare parfaits: Divide one half of the fruit mixture equally into 6 parfait glasses. Top with heaping tablespoon of yogurt. Add remaining fruit divided equally; top with remaining yogurt. Sprinkle each parfait with grape nuts. Garnish each parfait with a mint sprig.

These recipes were provided by FruitsAndVeggiesMatter.gov, a site sponsored by the Centers for Disease Control and Prevention (CDC), the U.S. Department of Health and Human Services, the National Cancer Institute, and USA.gov. Visit www.fruitsandveggiesmatter.gov for more recipes that will help you incorporate recommended daily servings into your diet.

12 Preserving Your Memory summer 2008 ALZTalk.org, is a free and easy way to make new friends and stay connected with those in the Alzheimer’s community. Join today to post messages and share pictures and favorite links. ALZTalk.org gives users a voice and allows them to share tips and stories about coping with loved ones with Alzheimer's. It also offers the ability to ask our experts questions no matter how large or small. Chat Online

Share Your Photos & Set Up Your Events Profile in 1 Easy Step Get Answers to Your Questions

Visit ALZTalk.org for the most comprehensive Alzheimer’s community resource online. Brought to you by the Fisher Center for Alzheimer’s Research Foundation and ALZinfo.org *Content has been altered to protect user identity and data. MetLife Foundation Awards Scientists for Research in Alzheimer’s Disease

14 Preserving Your Memory summer 2008 etLife Foundation recently gave their annual expected to grow in the years to come, particularly in Awards for Medical Research in Alzheimer’s countries with large Baby Boomer populations, such as MDisease. Awards were given at a special scientific the United States. Presently, there are more than briefing and luncheon in Washington, DC, to three 5 million people with Alzheimer’s in the United States scientists who have all individually made significant alone. Direct and indirect annual costs of caring contributions to the understanding of Alzheimer’s by for individuals with Alzheimer’s disease and other shedding light on beta-secretase and gamma-secretase dementias, including Medicare and Medicaid costs and enzyme activities in the brain—enzymes that play an the indirect cost to businesses of employees who are important role in Alzheimer’s disease. A past winner of this caregivers of persons with Alzheimer’s, amount to more prestigious award is Paul Greengard, PhD, Nobel Laureate than $148 billion annually. and director of the Fisher Center for Alzheimer’s Disease “These awards are an investment in the future. Scientists Research at The Rockefeller University. represent our best hope for one day finding the causes This year’s award recipients were: Bart De Strooper, and treatments for Alzheimer’s,” says Sibyl Jacobson, MD, PhD, of Belgium’s K.U.Leuven and VIB-Institute, president, MetLife Foundation. “We thank the awardees for his work on the cell biology of the amyloid precursor for their important contributions to the understanding of protein and gamma-secretase; Robert J. Vassar, PhD, of Alzheimer’s and commend their continued dedication to Northwestern University, for his research on the beta- scientific research.” secretase enzyme and molecular mechanisms of Alzheimer’s “As the population ages, research on Alzheimer’s disease disease; and Philip C. Wong, PhD, of the Johns Hopkins has never been more important,” says Dr. Butler. “If University School of Medicine, for his work on molecular unchecked, the medical and caregiving costs could very mechanisms and experimental therapies for Alzheimer’s well make Alzheimer’s the most significant disease of this disease. century. However, it’s the personal costs that are truly The awards program began with each of the award staggering, because Alzheimer’s gradually robs individuals recipients discussing their work. The briefing was of the person that they once knew. Through this annual moderated by Robert N. Butler, MD, president and award, MetLife Foundation has demonstrated sustained CEO of the International Longevity Center-USA, and support for scientists working to unravel the mystery of Professor of Geriatrics, Mount Sinai Medical Center Alzheimer’s, by providing leading scientists with the funds in New York City. Dr. Butler is the founding director to freely pursue their ideas and attest to the progress and of the National Institute on Aging of the National promise of research.” Institutes of Health. The Work of This Year’s Winners The History and Impact of the Awards Since 1986, MetLife Foundation has granted major Dr. De Strooper’s awards to scientists who have demonstrated significant multinational research group contributions to the understanding of Alzheimer’s disease. has shown the central role of At the heart of the awards program is a strong belief in presenilin in the production of the importance of basic research, with an emphasis on beta-amyloid in brain cells and providing scientists with the opportunity to pursue their the essential role of presenilin ideas. This year’s winners received a $25,000 personal in the cleavage of the Notch award, in addition to a $175,000 award to each of their protein, a major regulator of institutions, to further their research. brain and immune function. “The aging of the population means, unfortunately, The two findings set the that the impact of Alzheimer’s will increase in the coming stage for worldwide efforts years,” says C. Robert Henrikson, chairman, president, to identify gamma-secretase and CEO of MetLife, Inc. “The impact of Alzheimer’s Bart De Strooper, blockers to treat Alzheimer’s on families, society, and the economy is why MetLife MD, PhD without side effects caused Foundation has been committed for over 20 years to the by blocking Notch signaling, search for a cure.” and began a decade long inquiry involving researchers Worldwide, some 24 million people have dementia, from more than 15 countries that has led to dramatic with Alzheimer’s disease being the most common cause improvements in scientists’ understanding of the gamma- of dementia. The social, emotional, and economic secretase protein complex. Most recently it has been shown consequences of Alzheimer’s are staggering, and are that the gamma complex is actually four similar sub- summer 2008 www.ALZinfo.org 15 complexes, that one of the sub-complexes is more active the brain and the role the enzyme plays in the development in the brain, and that this sub-complex activity can be of Alzheimer’s disease. blocked without major side effects in mouse models. Dr. Previously, while leading a research team at Amgen, De Strooper’s team is currently developing new therapies Dr. Vassar and his colleagues were the first to clone and targeted at inhibiting gamma-secretase activity and characterize BACE1 and subsequently set out to validate screening drugs designed to do the job. that it was responsible for wreaking havoc in the brain. By creating mouse models without the gene for BACE1, Dr. Vassar’s latest Dr. Vassar demonstrated that the brains of such mice work includes innovative were free of the beta-amyloid peptide and that the mice explorations that could lead to appeared otherwise normal. The studies reinforced that gene therapy for the treatment BACE1 inhibition is a very promising target for Alzheimer’s of Alzheimer’s. He and his treatment. The team’s 1999 publication of their findings in colleagues are looking at Science magazine intensified scientists’ investigations into whether RNA-interference beta-secretase and launched the quest for small molecule of the beta-secretase enzyme inhibitor drugs. known as BACE1 can be used to reduce plaque levels in Dr. Wong was among the first to publish findings mouse models of Alzheimer’s. indicating the central role of presenilin in the development They have already shown that and regulation of the communication pathway between Robert J. Vassar, PhD genetic deletion of BACE1 brain cells, known as the Notch signaling pathway. Dr. prevents beta-amyloid- Wong’s discovery that knocking out presenilin activity dependent memory deficits, brain cell loss, and plaques in disrupts proper development of this pathway pointed to the mice. He is also working on the regulation of BACE1 in need for therapies highly targeted to the specific secretase

Keynote Speech by Kate Mulgrew eyed and honest into that good night. My mother’s name was Joan but everyone called her Jiki. The event’s keynote speech was delivered by noted actor, The bookends of my mother’s life reveal the full irony of her author, and Alzheimer’s advocate Kate Mulgrew. The story. Her own mother died in childbirth stamping my mother, popular actress, who has appeared on television, stage, and before she could even speak, with a wild hunger and a deep screen, mostly notably as Captain Kathryn Janeway in and solitary grief. Star Trek: Voyager, has had a long-standing commitment These currents ran through my mother all her life and, to Alzheimer’s and her recollections of her mother, who though they defined her, they did not deter her from living had Alzheimer’s, are found in the recently published book, the life she chose. She learned the gifts of passion and Voices of Alzheimer’s, and were also published in the Winter friendship early on, and when she stumbled upon my father, 2007 issue of Preserving Your Memory. she recognized a kindred spirit, and so they ran off together Ms. Mulgrew’s speech has been reprinted here for our readers: and had eight children in quick and alarming succession. I I’d like to first thank the MetLife Foundation for their was her second born, her first girl and, as she would later say extraordinary generosity to Alzheimer’s research. Apparently, (to the surprise and occasional horror of anyone who would someone very high up understands the urgency that this disease listen): “Kitten was my first daughter so, of course, she was my inspires, and has both the compassion and the wherewithal to favorite—she was the mother I never had.” act on it. I would also like to congratulate the scientists who She buried two of her eight children when they were very are being honored today, not only for their accomplishments, young; Maggie, as a baby, and Tessie, of a brain tumor, when but for their essence: They are the rara avis. Against all odds, she was fourteen. This last was a mortal blow and nearly cost they persevere, and in so doing, save us all. my mother her marriage and her sanity. She rallied, however, I’m at a stage in my life where, finally, I can accept that and with Baruch Spinoza as her mentor and art as her almost all experience is bittersweet—and I can accept, too, creative furnace, she became a celebrated painter, a maverick the inevitability of death. I think I will neither fear it nor personality, a remarkable example of grit and depth, wit and welcome it, as long as I can face it squarely and with some daring—we all loved her quite madly. dignity. After all, we have no say over our entrance into this For her 70th birthday, I took my mother on a cruise up world—the least we can ask as human beings is to go clear- The Aegean Sea. One night, looking at the Turkish moon and 16 Preserving Your Memory summer 2008 enzymes involved in amyloid provides benefits in the brain without adverse side effects. beta production. His latest work includes the development of methods to Influenced by Dr. Robert deliver therapeutic drugs designed to inhibit beta- and Vassar’s work, Dr. Wong’s gamma-secretases directly into the brain to avoid the side team moved quickly to develop effects of treatment outside the brain. ■ mouse models with the BACE1 gene knocked out, and validated that the enzyme is About MetLife Foundation an attractive therapeutic target for Alzheimer’s. Examining MetLife Foundation has supported the neurons of his mice, Dr. Alzheimer’s disease research and outreach Wong demonstrated that while activities for more than 20 years. The Philip C. Wong, PhD beta-secretase elimination Foundation has awarded over $11 million could have adverse effects in grants through its Awards for Medical on a developing brain, these effects may not show up in a mature brain. Dr. Wong turned his attention to the second Research in Alzheimer’s Disease program. cleaver in the beta-amyloid production process, gamma- For information about MetLife Foundation, secretase. Ongoing research on gamma-secretase has led please visit www.metlife.org. to the discovery that it is not a single protein enzyme but rather a series of enzyme complexes comprised of four different proteins. By developing mouse models with each of the gamma-secretase genes knocked out, Dr. Wong’s Actress Kate Mulgrew, team showed that moderate inhibition of gamma-secretase keynote speaker

drinking Irish whiskey, she wanted to talk about sadness. She told me that the greatest sorrow of her life was that she had never stopped searching for her mother and, whereas she knew this was emotionally irrational, she could manage it as long as she was intellectually sound. “My brain is the superior organ, and it gives me all my happiness,” she said. “I can read, paint, play the piano, laugh at your father, I can think and I can love. Want to

know how special the brain is?” she asked, pointing to the sky. “I Photo: Marc Baroni can see the moon, but the moon can’t see me.” A month later, she was diagnosed with atypical Alzheimer’s But even then she held on as, one by one, all of her children disease. She begged me to help her find a way out of the embraced her and bade her good-bye. nightmare but, of course, I didn’t. I couldn’t. You understand. I was the last to kneel by her side and, looking into her eyes, Instead, I just watched. I watched as my father, furious with I gave her a walloping dose of morphine and, as I cradled her denial, slowly disintegrated, until one day he crawled into his head in my arms, I wept and begged her forgiveness—because bed and died there, two weeks later. Cancer, they said, cancer I had born witness to this final mortification. My mother died everywhere—in his lungs, in his chest, on his brainstem. with her eyes wide open—unseeing, senseless, and without a I watched as my siblings, once so funny and charming and shred of dignity. irreverent, grew confused and suspicious and, unable to sever It looks like I may well be the genetic heir to this same fate— the bond they had always known with their mother, severed it that is, if I am truly my mother’s daughter—and so I urge with one another, instead. science, on behalf of my glorious and unexpected mother, to work I just watched. Of course, I was dutiful and vigilant. I hard and demand much and strive passionately to control this learned how to change her diapers, how to bathe her, how to disease, so as to spare my own sons the ultimate mortification of put the spoon to her mouth. I did all of this with a smile and having to bury a mother whom they love deeply but who, herself, studied, stupid expressions of affection. no longer knows or cares what love is. ■ One day, eight years after her diagnosis, she simply refused the spoon—and shortly afterward, she refused the water. summer 2008 www.ALZinfo.org 17 Long-term Planning By Bernard A. Krooks, Esq.

Planning for the Well Spouse

hen a spouse becomes ill, and organize your documents to see health, automobile, homeowners, the well spouse is sud- what you have, what long-term plan- life, long-term care Wdenly faced not only with ning is in place and what needs to be • Legal documents: last wills and tes- the emotional toll, but the burden of updated. Items to look for include: taments, trusts, and advance direc- handling all the finan- tives (power of at- cial responsibilities and torney, health care long-term planning on proxy, living will, his or her own. If the HIPAA release, and ill spouse always han- burial designation) dled the financial mat- • Financial informa- ters, even paying bills tion, including bank, can be overwhelming. brokerage, and re- But regardless of who tirement accounts; kept the family books, stocks and bonds; often the other spouse income; tax records; is in the dark on the debts; and bills family’s financial mat- • Any other important ters and recordkeeping. items, including: the Additionally, the well deed to your home, spouse may not know title and registration what long-term plan- to automobiles, and ning considerations safety deposit box have been made for him or her, or what is even Understand Your available. This article Present Situation will provide an outline Once you locate of things to consider your documents, it is and steps to take when important for you to the financial respon- learn what they are sibility and long-term and what purpose they care planning burden serve. Understand passes to the spouse who what your assets and has generally not had to expenses are. Regard- deal with these issues ing your assets, care- previously. Though not ful analysis should be always possible, it is It’s important to develop an understanding of made as to what type important to be as pro- your family’s financial matters. of account(s) you have, active as you can and how much money is in review and familiarize it, how the account(s) yourself with these matters before a • Identification documents: Social Se- is(are) titled (who owns it) and wheth- spouse becomes ill. curity card, Medicare card, birth and er there are any beneficiaries. marriage certificates Know what your income is and where Locate and Organize Documents • Military records it comes from. Does your spouse receive First, it is very important to locate • Insurance documents: including, a pension? If so, will it continue if he/ 18 Preserving Your Memory summer 2008 she predeceases you? Do you have any home or earned less than your spouse The additional 2 percent is designed to retirement accounts (including IRAs, during the time you were employed. cover administrative costs. 401(k)s, profit sharing plans) that you It is important to know that your full are required to take minimum distri- retirement age for retirement benefits Legal Documents butions from because you have reached may be different from your full retire- Make sure your legal documents are the age of 70½? ment age for survivor’s benefits. Also, in order and up to date. Set up an ap- Important resources are available to if you are receiving survivor’s benefits pointment with your elder law attorney aid you with this undertaking. Many you can switch to your own retire- to review them. If your spouse has be- senior centers offer programs to assist ment benefit if your retirement rate come ill, consider appointing someone with managing household finances and is higher than the rate you are receiv- else as your executor under your will or bills. They also may have volunteers ing for survivor’s benefits. The rules as agent under your power of attorney who will review your Medicare cover- are complicated, and, therefore, it is and health care proxy. You should re- age with you as well as your medical important that you carefully consider view with your attorney whether you bills so you understand what you are all your options before making a final need to establish a trust to protect your being charged. If your spouse dealt decision. assets should your spouse need long with the same bank for several years, term care either in a nursing facility or he may have developed a personal re- Health Insurance at home. lationship with them and they may You need to understand what type work with you to review your accounts. of health insurance coverage you have, Long-Term Care Additionally, an elder law attorney can including Medicare. If you have Medi- Long-term care is not limited to play a vital role in making this process care, review whether you have Part A, nursing homes. Today, most care is re- easier for you. He or she can meet with Part B and/or Part D. Also, if you and ceived at home and it is important for you either at your home or in the office your spouse have a retiree health plan you to understand what options you and go through and explain all of your through your spouse’s former employ- have available to you and your spouse. paperwork with you. er, does it continue if your spouse pre- Review whether you have long term deceases you? care insurance and what coverage it Simplify Your Life If it does not, you may be eligible provides. It is important to familiarize You can set up automatic bill pay- for COBRA. COBRA is federal leg- yourself with the differences between ments to have your utility, insurance, islation that allows former employees, Medicare and Medicaid and what each and telephone bills paid directly from retirees, spouses, and dependent chil- program can offer you. Geriatric care your checking account every month. If dren to temporarily continue group managers are available to assist you your spouse always prepared and filed health coverage that would otherwise with care planning assessments and income taxes on his or her own, per- be terminated. If you are covered by provide solutions to your individual haps it would ease the burden for you both Medicare and a group health long term care needs. by hiring an accountant to prepare plan as part of your spouse’s retire- If possible, it is important to review, your taxes. ment and your husband dies, then you understand, and work on these issues. may have the right to elect COBRA The more familiar you are with these re- Social Security continuation coverage with respect to sponsibilities, the more comfortable you If your spouse dies, it is important the group health coverage for the max- will become with them and less fearful to contact the Social Security Admin- imum period of coverage available (18 of handling them on your own. It will istration to advise of his or her death to 36 months). If you become covered help ease your burden and provide peace and to make sure you receive all of the by Medicare at any time after an elec- of mind so most of your attention can be benefits to which you may be entitled. tion of COBRA continuation cover- paid to your ill spouse. ■ You may be eligible for a one-time pay- age your COBRA continuation cover- ment of $255. Also, if you are consid- age will probably end. It is important Bernard A. Krooks, J.D., CPA, LL.M (in ered full retirement age for survivor’s to know that you only have 60 days taxation), CELA is immediate past President benefits, as defined by the Social Se- from the date of your spouse’s death and founding member of the NY Chapter curity Administration, you can receive to elect COBRA coverage so action of the National Academy of Elder Law At- Social Security benefits based upon must be taken promptly. Also, CO- torneys and a nationally known and widely your deceased spouse’s earning record. BRA coverage can be very expensive quoted expert on elder law. For more in- This can be a significant amount if (i.e., employer can charge up to 102 formation, visit the firm’s website at www. you either did not work outside of the percent of the employer premium). littmankrooks.com. summer 2008 www.ALZinfo.org 19 By Jennifer Sellers

10 OUTDOOR Activities A picnic is an easy way to spend time outside, and you to Enhance can have one anywhere. Your Loved One’s SUMMER ong daylight hours and a relaxed dress code make By getting out in the early morning or late afternoon, summer the perfect time of year to get out of the you can still enjoy a reasonably comfortable walk while Lhouse and enjoy the great outdoors. And while there avoiding mid-day heat. are many activities for the young, there are also plenty for the young at heart. Here’s a list of outdoor activities that 2. Shop at a farmers’ market. Summer is the prime time are suited for Alzheimer’s patients and their caregivers. Try to shop farmers’ markets. There are numerous crops to incorporate these activities into a regular schedule, when in season June through September, which means there possible. Regularity is generally important for a person with will be a variety of fruits and vegetables—straight from Alzheimer’s. It reduces anxiety and stress when the regular the farmers who grow them. Many of these markets activity is enjoyable. have outdoor stands during the summer months, so you can spend time outdoors while hunting for nutritious, 1. Take an early morning or late afternoon stroll. memory-preserving foods such as carrots and leafy Studies have shown that simple exercise on a routine greens. Plus, seeing colorful foods can lead to better basis, such as taking a walk every day, may help improve eating habits in people with Alzheimer’s. mood and decrease anxiety in Alzheimer’s patients. 20 Preserving Your Memory summer 2008 5. Bird watch in your back yard. Bird watching is a popular hobby in the United States. It’s something that can be enjoyed by the entire family, and it only requires a pair of binoculars or just your own two eyes. It will allow you to discover the variety of birds in your own region—even in your own neighborhood—while letting you view the habits of our feathered friends. You might even want to add bird feeders and birdbaths to your property to attract a greater assortment of birds. The rhythmic motion of a swing can be soothing to a loved one with Alzheimer’s.

3. Spend time on a porch swing. The image of a swing softly swaying on a front porch is a slice of Americana. Whether it brings back memories of a scene from The Andy Griffith Show or just a lazy summer evening from your own childhood, it’s sure to ignite pleasant memories. Plus, the rhythmic motion of the swing can Bird watching can be enjoyed be soothing to a loved one with Alzheimer’s. by the entire family.

4. Visit a local park. Have you checked out your city’s parks and greenways lately? Most parks no longer consist 6. Enjoy a concert in the park. If you want to enjoy of just a playground and a duck pond. These days, city outdoor music, summer is the time to do it. Parks, as parks are professionally landscaped havens filled with well as outdoor arenas and shopping centers, are likely beautiful vegetation, meandering walking trails, and even to have some kind of live music at least once during the sculptured art. A park can be a peaceful place for walking season. If you plan on attending one of these events with or just meditating on the beauty of your surroundings, your loved one, you might want to attend a concert that and this environment can provide stimulation in a low- features music you know the person with Alzheimer’s stress setting. But make sure the person with Alzheimer’s likes. Outdoor concerts may feature more easy-going is comfortable and not intimidated, even by what seems music, such as string quartets or jazz ensembles. Some to you to be a friendly environment. This is why keeping may highlight big band or beach music—genres that to a regular schedule is important in caring for a person could bring back memories for you and your loved with Alzheimer’s—regularity can lead to familiarity. one. Be cautious of crowds, however. A person with Contact your local parks and recreation department to Alzheimer’s may feel anxious and helpless around locate parks near you. strangers or groups of people.

(If you’d like to learn more about how music can trigger memories in Alzheimer’s sufferers, view our spring 2008 edition of Preserving Your Memory at www.alzinfo.org/ spring08.)

7. Explore your city’s downtown district. Instead of getting in your car to drive from one shopping center to another, take your errand list downtown and walk from store to store. Main Street USA is no longer a neglected, irrelevant part of American communities. The latest trend Most parks no longer consist of in towns big and small is the revitalization of downtown just a playground and a duck pond. districts. Business owners are refurbishing historic buildings that were once in danger of being condemned summer 2008 www.ALZinfo.org 21 and making them part of unique shopping, art, and historic districts. Exploring the businesses in your city’s downtown district can be quite fun. Where else can you find a 100-year-old jewelry store in-between a frozen yogurt shop and a historic marker? Certainly not at a strip mall.

8. Stargaze on a clear night. Summer is one of the most temperate times to sit outside on a late evening. Stargazing can include the use of a telescope, or just Pack sandwiches, pick up some the naked eye. Check your library or the Internet for take-out to bring with you, or guides on the stars, planets, and constellations visible grill out in your backyard. in your hemisphere at any given time. By following the local news, you can also find out when a meteor shower is likely. Just remember: A person with Alzheimer’s generally doesn’t function as well in the Spending time outdoors is an important way to help evening. This is called “sundowning.” If this is applies your loved one with Alzheimer’s disease remain connected to your loved one, stargazing may not be the right to the world around them. Several recent studies have activity for him or her. shown that recreational activities, similar to those listed above, improve the symptoms of Alzheimer’s in terms of reducing disruptive and agitated behavior. Even more strikingly, Alzheimer’s patients have shown improvement in memory and in activities of daily living after recreational stimulation. In fact, compared to cognitive therapy alone (e.g., memory exercises), recreational therapy appears to lead to a greater improvement in functional status. So, try out some (or all) of these activities this summer to interact with nature—and others—in safe, fun, and beneficial ways. ■ Shell collecting can be a quiet, simple activity By getting out in the early morning to share with your loved one. or late afternoon, you can still enjoy a reasonably comfortable walk while 9. Collect seashells. Whether you live by the sea or avoiding mid-day heat. only make an annual visit, shell collecting can be a quiet, simple activity to share with your loved one. The sound of the waves and the texture of the sand can be soothing, while looking for shells can provide a sense of adventure to your outing. You may even find that the person with Alzheimer’s is captivated by handling the shells. Later, you can incorporate the shells into decorative or craft projects so that your family will be reminded of the beach all year long.

10. Have a picnic. A picnic is an easy way to spend time outside, and you can have one anywhere—on your patio, at a park, on the beach. And as far as the food goes, you can pack sandwiches, pick up some take- out to bring with you, or grill out in your backyard. Regardless of what you eat or where you eat it, the joy of a picnic is in setting aside a special to time to dine with friends or family in a relaxing environment. 22 Preserving Your Memory summer 2008 Fisher Center Research

“Scientific discovery brings new hope for memory preservation.” ~Journal of Experimental Medicine

NA (short for ribonucleic acid) These tests suggest that if has been known for nearly half microRNAs began to lose function R a century to be used by cells to in other types of neurons, such as make proteins. More recently, a new those involved in memory and higher kind of RNA was discovered. Because thinking, a condition similar to of the small size of its molecules, Alzheimer’s might develop, says the compared to other forms of RNA, this study’s lead author, Anne Schaefer, new type was given the name “micro” PhD, MD, a postdoctoral fellow in RNA. Research has shown that Greengard’s lab. These findings are microRNAs help regulate the functions “very exciting,” she says. of genes. Since their discovery in 1993, New research from the Fisher microRNAs have been found to have Center for Alzheimer’s Research at powerful effects on genes in cells that The Rockefeller University shows that are still developing. For example, when brain cells are prevented from developing neurons make a large producing microRNAs, they slowly die variety of microRNAs, Dr. Schaefer in a manner similar to what is seen in says, and the development of these Alzheimer’s disease and other human brain cells stops if microRNAs are neurodegenerative disorders. In the prevented from functioning. While Journal of Experimental Medicine, Fisher these bits of RNA were also known Anne Schaefer, PhD, MD, scientists say that although no one has to exist in mature neurons, no one yet found microRNAs to be involved in a postdoctoral fellow in knew if they played any role in the any disease, their study in mice shows Dr. Greengard’s lab. life of adult neuronal cells, she says. that these tiny snippets of RNA are The discovery that microRNA affects essential for survival of mature brain play in the brain, the research team bred mature neurons suggests that they cells, also called neurons. mice in which a gene known as “Dicer” function in the adult brain. “This research tells us that microRNAs could be “turned off” at any moment Whether changes in specific are needed if certain neurons are to desired. It was previously known that microRNAs contribute to human function and survive, and that means Dicer is required for the production disorders, like Alzheimer’s disease, they are likely involved in survival of other of microRNA. So by turning it off in remains to be seen, says Dr. Schaefer, neurons as well,” says the study’s principal mature neurons, the scientists could but now researchers have ways to test investigator, Dr. Paul Greengard, Nobel determine whether these mature cells that. They can compare microRNA laureate and director of the Fisher Center still needed microRNA to function expression between normal and for Alzheimer’s Research. “That leads and survive. The scientists chose to Alzheimer’s human brains, and they can us to hypothesize that abnormalities in turn Dicer off in a type of neuron that knock out specific microRNAs in an microRNA expression might be causing was known to affect movement. The Alzheimer’s mouse model to determine or modifying disease progression.” mice then began to show symptoms which may be playing the more critical This means that if micoRNAs are not of movement disorder, reminiscent of roles. “Now we have a roadmap for produced properly in brain cells, disease human neurodegenerative disease. At identification of genes that might be is likely to occur. the same time, the neurons in which involved in neurodegeneration, and that To find out what role microRNAs Dicer was turned off began to die. is very exciting,” Dr. Greengard says. ■ summer 2008 www.ALZinfo.org 23 Caregiver Voices A Taboo Moment Christina Angelacos shares an excerpt from her caregiving memoir.

s always, my trip felt too short. remembered complaining about the every bead of perspiration that dripped There was never enough time to neighbors in the first place. Then the from my forehead onto the clamped sill. A get it all done. There were always semi-rational idea hit me: “OK, Dad, Locked. Of course. Some sort of senior- so many requests, so many adjustments, here’s what we’ll do: We’ll move your proofing fixture had been installed to so many to-dos that I never left my bed to the opposite side of the room so keep disgruntled residents from hurling father and returned to New York feeling you won’t hear your neighbors so much.” themselves out the window, which was a sense off accomplishment. It wasn’t the most elegant solution, and a thought I was seriously considering at I had 45 minutes to say goodbye to certainly not the most efficient, but it was the time. Dad before heading to the airport. His the best I could do in … 28 minutes. Then I fiddled with the digital display last request before I left was to help It seemed like an easy enough task. His on the air conditioner, pressing the him with “the voices.” Apparently, the bed was small beneath the disheveled down arrow in a mad frenzy with no neighbors next door were keeping him sheets. My plan was to maneuver his luck. It was frozen at 78 degrees. I tried awake at night with their mumbling. bed into a 90-degree angle then shove unplugging it then plugging it back At this point, I still took everything it into the opposite corner of the room. in. I slammed the display pad with my seriously—taking great care to ensure Now I had 26 minutes to complete my sweaty fist. Nothing. My blouse was each time before I flew home Dad was mission. But as I reached 45 degrees I soaked, my hands were slippery, and left in good spirits, as comfortable as noticed something was wrong. The left my watch kept ticking ... 8 minutes. possible, with all adjustments made, side of the bed was no longer moving. I looked behind me at my father’s and all items crossed off the list. But I shoved harder and felt an unrelenting broken bed. He probably doesn’t even this current request was a bit more pull on the carpet. Something was stuck, remember that people live next door, complicated than the others. hard. I peered underneath to find one and I’ve broken his poor little bed and I racked my brain for a useful quick of the wheels was completely missing messed up his room—his un-matching fix—one that would help him and from the frame. Dad had actually been sheets now strewn across the floor, the still get me back to New York on the sleeping on a lopsided bed and never skinny mattress bending at the center. last flight out. I was desperate for a knew the wiser. I glanced at my watch I was supposed to make it better but I 30-minute solution. I could pass the … 19 minutes and counting. made it worse. And to top it off, I had buck to the ladies at the front desk, but Inch by painstaking inch I tried to fly back to New York and leave him I knew once I walked out that door it twisting and turning each corner but with his messy broken life. would be dropped. One of those Zen without the fourth wheel this was a I could feel the guilt descending like alarm clocks with crashing waves or mere impossibility. I began to sweat. The a storm cloud, then the tears … no, he thunderstorms might do the trick, but metal continued to grind further into cannot see me like this. I only had 5 my chances of making it to Walgreens the thickness of the carpet. Suddenly minutes to clean up the ridiculous mess before closing were slim. I considered something gave and half of his bed came I created and do right by Dad. With just knocking on the door and talking flying two feet out from under me. The one final surge, I lifted the mattress to the neighbors myself, but there was frame slid completely off-track and was with one arm and strained to connect no way to accomplish a polite sit-down now totally unhinged; the front and the metal fame with the other. It was in 30 minutes or less back portions of his bed fully separated. I a ludicrous, senseless attempt. Within I had a half hour to come up cursed under my breath … 12 minutes. two seconds I was sitting on the floor with an answer and I could feel my Still sweating, I dropped half the defeated. I was as broken as his bed— anxiety mounting. I considered the bed and reached to open his window beaten, flattened. I’d lost it, despite my ridiculousness of my own anxiety for relief. I pulled the metal lip of the valiant attempt to stifle the sobs as the as I wondered to myself if he even window hard, irritation building with tears came streaming. 24 Preserving Your Memory summer 2008 “Honey?” My dad was in the that night. The exchange was doorway. I can only imagine a final farewell to the familial his alarm as he surveyed his roles we once knew. It was the disassembled bedroom. I most melancholy yet poignant didn’t answer. I sat on the milestone we’d ever shared. floor with my back to him, I realized that day that frozen. He couldn’t see me my father’s disease could break down like this. This was be dealt with in two ways. a taboo moment. He could One way was to dwell on the never know that anything problems and the attempts to I did for him hurt me. He incessantly aid the symptoms could never know things were and handicaps—the things tiring or burdensome or heart- to-do lists are made of. I wrenching like this. He was thought if I could somehow supposed to let me take care make Dad’s life easier, it of things like a good daughter would relieve me of some of would; he was never supposed the guilt. But the chores never to know this was killing me. end, and the lists just seem “Honey?” He asked louder to multiply. There is never this time, his voice thick with enough that can be “done” to concern, which made me cry cater to the handicaps. even harder. “It’s OK, Dad,” I said, After that day I learned to trying my best to sound normal. “There was never view the time I spent with my “I can take care of it—just go enough time to get it father in a different light: To back in the other room, OK?” all done.” weigh our moments together as But he didn’t say OK. quality rather than quantity. At “Honey? Are you hurt?” He the beginning, I didn’t want to started toward me. view my father in a reversed role. “No, Dad. It’s OK—SERIOUSLY.” I sadness was far more permanent. I held I secretly wished he would remain “Dad,” said louder as if the volume of my voice onto him tightly and sobbed in his ear, just as he always had, but with a few would stop him. But it was too late, and “Dad, I’m so sorry,” I said between sobs. handicaps—things that could be fixed. he was directly behind me, hand on “I didn’t want you to see me like this.” It took courage to face the truth and my shoulder—much too close for me “It’s OK, honey,” he kept repeating. accept Dad as he is, rather than as he to stave him off with words, no matter It was at that point our roles reversed, used to be. Only after I acknowledged how loud or seemingly authoritative. and we cried because we didn’t want to Dad’s Alzheimer’s completely, with all I had to look up, to face him in all let go of the relationship as it was, and of its misgivings, did I learn to relax and my brokenness. I turned around to his as it had been for the past 34 years. enjoy my time with him—not as much embrace and lost control, the tears now I missed my plane that night. I in the doing, but in the being. ■ coming hard and fast. We were both never told my father; I just checked crying now, and for a fleeting moment into the Marriott down the street and By Christina Angelacos, New York I succumbed to being his little girl collapsed. I sat in the anonymity of the again, allowing him to comfort and hotel room and broke down where no We’d Love to Hear protect me one last time. “Honey, I’m one could see. I pondered that taboo sorry you’re hurt,” he said. And I was. I moment when my father caught me From You was more hurt than I have ever been in crying and childlike. I played the Join Christina, and share your my life, but not in a physical way. scene over and over in my mind, the caregiving story with other It was the first time I’d seen my father two of us hugging and crying, clinging readers. Contact The Fisher cry. Thankfully, he was convinced I’d to that delicate bond we shared as Center for Alzheimer’s Research somehow injured myself while moving father and daughter—so unready Foundation, West 46th Street & 12th Avenue, New York, his bed, and his attempts to soothe me to let go. Our roles were inevitably NY 10036, or e-mail them to were just the same as if I’d had fallen off reversing, and neither of us could halt [email protected] my bike and skinned my knee. But my the progression. We said our goodbyes summer 2008 www.ALZinfo.org 25 Gardening By Michelle Porter Tiernan

Easy Summer Gardening Soothes the Soul: Tips from Gardening Expert and HGTV Host Justin Cave Learn about the benefits of gardening for Alzheimer’s patients and their caregivers.

orking in a garden creased risk of falls, reduced can make you feel wandering, and delayed nurs- Wlike a kid again. Feel- ing home placement for people ing the sun on your face, dig- with Alzheimer’s disease. ging your hands in the dirt, As a caregiver, you may view and watching with wonder as gardening as too labor-inten- plants blossom and bear fruit sive, but working with nature can evoke warm childhood does not necessarily mean a lot memories. As an adult caregiv- of time or extra work. Caring er, sharing these simple joys can for a garden can be as ambi- lighten your heart and provide tious as growing a variety of physical and mental benefits vegetables in your backyard to to both you and the person for simply planting a small con- whom you’re providing care. tainer of herbs on your win- “Gardening is beneficial for dowsill. people of all ages,” says Justin Whether growing a garden Cave, host of the new Home indoors or outside, Cave rec- & Garden Television (HGTV) ommends easy gardening jobs show Ground Breakers. “A veg- to get a person with dementia etable garden is a great way to get involved, such as pulling weeds, physical activity, and it can add deadheading flowers, watering nutrition to your routine.” plants, and picking vegetables. Garden tasks are simple, re- Justin Cave, host of Although some chores, like petitive chores that relieve HGTV’s Ground Breakers pruning shrubs or trees, may be stress and provide a sense of ac- too difficult for an adult with complishment. Just try pulling some Grow Some Muscle Alzheimer’s, there are many simple weeds or picking the first tomato of Gardening provides a great workout. tasks that anyone can do, like collect- the season, still warm from the sun, Digging, raking, and hoeing stretch ing coffee grounds and eggshells to and you’ll understand why gardening and strengthen muscles. Working in a start a compost pile. can be so rewarding. Scientists suggest garden is an excellent form of exercise If you have a yard, raking leaves or that the mental and physical stimula- for elderly adults and actually may help sweeping grass clippings off the side- tion produced by activities like gar- many people with dementia feel better, walk can provide a sense of accom- dening might stimulate production of both physically and emotionally. Ac- plishment for a person with dementia. new brain cells in the hippocampus, cording to the Mayo Clinic, exercising “It can be something as simple as go- the part of the brain that processes re- as little as 20 minutes, three times a ing out in the yard and filling the bird cent memories. week provides a boost in mood, a de- feeder,” Cave says. 26 Preserving Your Memory summer 2008 A person with Alzheimer’s who may reap the rewards of gardening. Con- deep for vegetables or perennials. not be able to participate in gardening tainer gardens, planted indoors or out- Your container garden also should tasks can still enjoy the experience of side on a deck, porch, or patio, are an have adequate sunlight. For example, being around plants and trees while easy option. Pots of small vegetables, leafy vegetables such as cabbage and you work, says Cave. “Push the wheel- flowers or herbs are versatile and simple lettuce do well with more shade, while chair outside in nature so you can talk to maintain. vegetables like cucumbers and toma- to your loved one while working.” A sunny kitchen windowsill is the toes need much more sun. Cave says all perfect spot for an herb garden. Grow indoor container gardens should be lo- Revive Your Senses your own rosemary, thyme, mint, ba- cated near a window exposed to at least Working outside in the wind and sun sil, and sage, either individually in their four to five hours of sun each day. with the sounds of insects and birds and own terra cotta pots or together in one Cave suggests purchasing flats of flow- the smell of grass and blooming flowers is long window box. ers and plants for “instant gratification,” a refreshing change and rather than starting mental release for anyone plants from seed. Pots who spends a majority of can become heavy once time indoors. Just smell- the potting soil and ing a fragrant herb or plants are in place, so sit seeing a brilliant flower larger container gardens can spark conversation on a plant caddy—a and coax a smile. caster on wheels—to Cave says spend- make them easier to ing more time outside move. is helpful not just for adults trying to pre- Enjoy the Show serve memory, but for “At the heart of gar- people of all ages. Gar- dening there is a belief dening is a sensory ex- in the miraculous,” perience, from feeling a writes English author summer breeze on your and gardener Mira- cheek to gathering col- bel Osler. Gardening “Gardening is beneficial for people of all ages.” orful vegetables. The brings joy into our smell of freshly mown – Justin Cave lives, from the antici- grass or the chirping of birds can bring Vegetable and herb essentials for pation of waiting for the roses to bloom back warm memories of the past, even favorite recipes can be planted in one to discovering a ripe melon hiding be- for people with dementia. Most of us container and placed outside on a back neath a cover of vines and leaves. recall helping or watching our parents porch for convenient gardening that Working in a garden offers a bounty nurture house plants, grow a vegetable only requires stepping outside the door. of benefits for both caregivers and loved garden, or work in the yard when we Oregano, basil, red peppers, and onions ones with Alzheimer’s, including stress were young. can be planted together for pizza lovers, relief, exercise, and simply the pride from Cave’s grandfather was diagnosed while a container garden of onions, to- growing and harvesting your own herbs with Alzheimer’s disease two years ago, matoes, cilantro, and chili peppers pro- and vegetables. Plus, it’s always rewarding and he recalls how much his grandfa- vide all of the ingredients for making to share a basket of extra tomatoes, fresh ther enjoyed working with nature. “He spicy, homemade salsa. basil, or green peppers with your family used to have a vegetable garden,” Cave Whether your container garden is in- and neighbors. says reflectively of his grandfather. “He doors or outside, the key to choosing Can’t you just smell the rich, loamy seeded the garden, which is the old the right container is to make sure it scent of the earth as you dig your hands timer’s way.” has good drainage holes, recommends into the dirt? Cultivating a garden is HGTV. Adequate drainage from wa- satisfying work, from planting, water- Keep it Simple tering prevents the plant’s roots from ing and weeding to simply stepping You may not have the time or energy constantly sitting in water, which can back and enjoying nature’s show, for to cultivate a full-size vegetable garden, rot the root and kill the plant. The con- both Alzheimer’s sufferers and caregiv- but you and your loved one can still tainer also should be at least 10 inches ers alike. ■ summer 2008 www.ALZinfo.org 27 Ask the Experts Do you have a question you would like to ask the experts at the Fisher Center for Alzheimer’s Research Foundation? If so, please call 1-800-ALZINFO, visit ALZinfo.org, send surface mail to Fisher Center for Alzheimer’s Research Foundation, West 46th Street & 12th Avenue, New York, NY 10036, or e-mail [email protected]. Summer Safety Tips

Q: Experts say that exercise and outdoor activities can be Use lots of sun block important for Alzheimer’s pa- and drink plenty of water. tients, as well as anyone trying to stay healthy, but is it really safe to spend time outdoors during the summer months?

A. Yes. As long as you’re cau- tious, summer can be a won- derful time of year to spend out- doors (See our article on page 20 for a list of outdoor activities you can try with your loved one this summer.) And you’re right that doing so can be beneficial to persons with or without Al- zheimer’s. In fact, studies show that physical as well as visual access to nature helps people recover from illness quicker, reduces stress, and lowers blood pressure. And spending time outside helps a person maintain circadian rhythms (the sleep/wake cycle). In addition, spending time outside might also help ensure the person with Alzheimer’s gets beneficial exercise.

Here’s a look at general summer safe- ty guidelines for everyone:

Be Safe in the Sun The sun supports life, but it poses are two of the most serious, but sun- avoid ill effects of sun exposure, follow risks, too. What are the dangers of too burn, dehydration, and heat exhaus- these guidelines. much sun? Skin cancer and heat stroke tion are also potential problems. To • Avoid spending prolonged periods 28 Preserving Your Memory summer 2008 of time outdoors from 10 a.m. to 4 the shore. If you’re caught in a rip p.m. The sun is most direct during current, swim parallel to the shore these hours, increasing the likeli- until you are out of the current. hood of sunburn. For more water safety information, • If you are outside during the mid- visit the NCIPC drowning preven- dle of the day, seek shade whenever tion webpage at: www.cdc.gov/ncipc/ possible, don’t overexert yourself, factsheets/drown.htm wear clothing that covers exposed skin, and wear a wide-brimmed Be Safe on the Road hat. Use lots of sun block and Many people travel by car to their drink plenty of water. summer vacation spots. To avoid driv- • Wear sunglasses that block 99 per- er fatigue and stay alert on your jour- cent to 100 percent of UV rays. ney this summer, the National Safety When the eyes are chronically Council recommends the following: exposed to the sun, they become • Get plenty of rest the day before more vulnerable to cataracts and a you leave. host of other problems. • Don’t drive alone. • Be aware that the elderly, small • Don’t set the cruise control—do children, and people with health Don’t swim without a the driving yourself. problems are more at-risk of heat lifeguard present. • Keep the temperature cool. stroke and heat exhaustion. • Play the radio. • Check the UV Index. Developed • Stop every two hours to stretch by the National Weather Service • If you have a swimming pool at your legs. and the EPA, the UV Index fore- your home, install a four-sided, casts the expected risk of overex- isolation fence with self-closing Be Safe in Your Environment posure to the sun, and how much and self-latching gates around the Whether you’re enjoying a picnic in protection should be taken when pool. The fence should be at least the park or an evening in your backyard, outside. The UV Index can be 4 feet tall and completely separate follow these additional precautions: found in your local newspaper, on the pool from the house. • Pay attention to air quality. radio and TV news reports, and on • If you don’t know how to swim, Ground-level ozone can form on the Internet. enroll in a swim class. hot summer days, making breath- More sun safety information can • Learn how to perform CPR (car- ing difficult, particularly for the be found online at the EPA’s SunWise diopulmonary resuscitation)—it is sick and elderly. Daily weather re- School Safety site, at www.epa.gov/ particularly important for anyone ports usually provide an index for sunwise. involved in water recreation. air quality. If the air quality index • It is important to refrain from is high (over 100), you should stay Be Safe in the Water drinking alcohol before swim- indoors as much as possible. Aquatic exercise can be a great part ming, boating, or water skiing. • Whether it’s bees, snakes, or jelly- of any fitness regimen (See page 30 for • Swimming in the ocean requires fish, summer is filled with things an article on this topic.), but you should several precautions. Thunder- that bite, sting, and pinch. Always always exercise caution around wa- storms and strong winds are dan- be aware of your surroundings and ter. According to the Centers for Dis- gerous to swimmers, so know the keep a first-aid kit on hand for ease Control and Prevention (CDC), local forecast and weather condi- emergencies. drowning is the fourth leading cause tions. Always swim within the of death in the United States, claiming area designated, usually marked This list might seem overwhelming, 4,000 lives each year. by buoys. Watch for rip currents, but most of this advice comes down to Here are some water safety tips from which are fast moving flows of sur- caution and common sense. Have fun the National Center for Injury Preven- face water that move out to sea. this summer. Get in plenty of benefi- tion and Control (NCIPC): They can sometimes be recognized cial exercise, and enjoy spending time • Neither adults nor children should by unusually calm water, water of with your family and friends. Just be swim alone or without a lifeguard a different color than surrounding sure to know your limits and look out present. water, and a low water line near for those you love. ■ summer 2008 www.ALZinfo.org 29 Fitness

The Power of Water Aquatic exercise offers many options for all fitness levels.

hether it’s the hypnotic shim- man, ideal for everyone from athletes to cardiovascular system. Plus, it’s an ideal mer of light dancing off a senior citizens. Because the buoyancy way to shed weight and reduce body Wlazy pond or the rhythmic of water “lowers” a person’s weight by fat. For example, it’s estimated that pulse of a crashing ocean wave, water almost 90 percent, stress on joints and a 150-pound person who swims at a enchants like no other element. So it bones is virtually eliminated, and the 50-yard-per-minute pace can burn 240 should come as no surprise, really, that added support provided by the water calories in 30 minutes. people seek to surround and immerse allows a fuller range of motion. At the themselves—figuratively and literally— same time, water exerts much more re- Water Aerobics in these three readily abundant atoms. sistance than air, so the effort required Water aerobics—quite simply, per- And for those looking to incorporate during exercise in water is greater. As forming a series of rhythmic body fitness into their lives, there’s no place such, aquatics can be used to strengthen movements and dance steps in water— quite like the water, and there are few muscles, enhance cardiovascular fitness are designed primarily to improve car- exercises more beneficial than the ones and endurance, and improve flexibility. diovascular health. The exercises, which performed in a bathing suit. In addition, exercise has been shown to can be performed in waist- to chest-deep “Being in the water makes people feel improve cognitive functioning. water or in deep water with flotation de- good,” explains John Spannuth, presi- “For most people, swimming or vices, are ideal for stroke victims and dent and CEO of the U.S. Water Fitness aquatic exercise is a huge benefit because people with conditions such as arthri- Association. “I can remember a lady in it is non-weight-bearing,” says Margot tis, neck and back problems, and obe- her 80s [with numerous health prob- Putukian, MD, director of primary care sity. What’s more, water aerobics require lems] who was a water walker. She said, sports medicine and team physician at more energy than land-based aerobics, ‘I feel so bad, but just being in the water Penn State University. “So, it allows accounting for a burn rate of 450 to makes me feel so much better.’” them to get a good cardiovascular work- 700 calories per hour of aerobic activ- In addition, the physical activity that out without putting a lot of pressure on ity. To vary and toughen the routines, comes with aquatic exercise can actually their knees, ankles, and back.” water aerobics instructors often use aqua help improve memory. Researchers at The non-impact nature of water ex- blocks (small barbells made for the wa- the Rush Alzheimer’s Disease Center in ercise makes it ideal for people who ter), gyrojoggers for the hands or feet Chicago found that for healthy seniors are overweight, those who suffer from to increase resistance, kickboards, and with intact memory (average age was musculoskeletal problems such as ar- aqua steps. 80), the risk of becoming disabled fell thritis, and patients trying to recover For those who prefer a more “tradi- 7 percent for every hour spent each week from stress fractures and other injuries. tional” form of exercise, experts rec- being physically active. Exercise is also In fact, Dr. Putukian advocates aquatic ommend water walking or running. important for persons who already have work for everyone except those who They offer many of the same benefits Alzheimer’s, and experts recommend suffer from osteoporosis or osteopenia, as walking or running on land, but the that it be continued as long as possible. where weight-bearing exercises are often resistance of water makes each activity The advantages of exercise for Alzheim- prescribed to help stimulate the body to more physically taxing. Intensity can er’s patients include improved mood, prevent further bone loss and increase be adjusted by choosing different water maintenance of muscle strength, and bone density. levels and changing directions intermit- possible prevention of other diseases. Naturally, swimming is the activity tently; however, most people walk at a that comes to mind when one thinks of level between the navel and the neck, Non-impact Exercise water-based activity. Often cited as the while most water runners use a flotation Experts contend that water exercise, “perfect exercise,” swimming strength- device and jog in water where their feet also known as aquatics, provides one of ens virtually all of the major muscle can’t touch the pool bottom. the best non-impact workouts known to groups as well as the respiratory and 30 Preserving Your Memory summer 2008 Building Endurance As with any exercise, the effectiveness of aquatics depends upon frequency, in- tensity, and duration. “You can’t waddle back and forth in the water and expect miracles,” Spannuth notes. For true aerobic benefits, Dr. Putukian suggests training at least three times per week, beginning with 15- to 20-minute work- outs then gradually increasing duration. “People may have difficulty with swimming or they may go up and down once or twice and be done—but that’s okay,” Dr. Putukian notes. “You can do three or four laps the first day, then rest and try another one, and so on until you eventually get to the point where you can do 20 or 25 laps without stopping.” Water exercise is one of the best non-impact Because aquatics are “a little more for- giving,” she also doesn’t dissuade more workouts—and is ideal for senior citizens. frequent workouts, including up to sev- en days a week. So, you may ask, is swimming the per- fect exercise? Perhaps—for some people. Living with One thing’s for sure, however: People from all walks of life are discovering the physical, psychological, and social ben- Alzheimer’s Disease efits of exercising in the water. Products That Make Life Easier, Simpler, and Safer

Exercising Caution in the Water The Alzheimer’s Store is dedicated to providing unique products and Water exercise may be right for you but information for those caring for someone with Alzheimer’s disease. not for your loved one with Alzheimer’s Every product in the store has been carefully selected to make living disease. While maintaining a reason- with Alzheimer’s disease as easy as possible. The store also provides able level of exercise is important to the a rating system for products that tells potential buyers whether overall health of Alzheimer’s patients, a particular product is for the early, middle, or late stages of the the type of exercise any patient engages disease. For example: in should be individualized to his or her abilities. You should talk with your ❖ A telephone that allows the user to push doctor about whether exercise is right the picture of the person they want to call. for both you and your loved one. Even For those who may be a little forgetful or if your loved one is a lifelong swimmer, who have difficulty seeing the numbers, you should not allow them in the wa- this phone is a blessing. ter without supervision, and it might be recommended that they remain in shal- With over 200 products that address various activities of low sections of the pool. daily living and caregiver challenges, the Alzheimer’s Store is However, if your loved one is particu- dedicated to finding and providing products for people with larly fond of the water, you can create Alzheimer’s disease and those caring for them. an aquatic exercise routine that the two of you can enjoy together. Something as For more information and many more helpful products, simple as walking laps in the pool can go to www.alzstore.com or call (800) 752-3238. be a soothing and physically rewarding activity for both of you. ■ summer 2008 www.ALZinfo.org 31 Take Action By Lauren Croughan The Alzheimer’s State of the Union Learn how the federal government and your home state are addressing Alzheimer’s disease.

he statistics are clear: Alzheimer’s • Texas: This government instituted a help to caregivers and increasing public is a problem that affects millions statewide Silver Alert to report miss- education about prevention. The major- Tof American lives, and will affect ing senior citizens. ity leader determines in what order bills millions more until better treatments or To learn more about your state’s efforts are debated, and there is a chance discus- a cure are found. With all the talk sur- in the fight against Alzheimer’s disease, sion of this bill will be delayed. rounding the subject, what is being done contact your district’s representatives. If you would like to urge the Senate about attaining this goal? to discuss S.B. 898, contact the office Your role in helping preserve memory Federal Initiatives of Senate Majority Leader, Harry Reid for untold millions may be as simple as The news on the federal level is mixed. (D-NV). His Senate webpage is http:// contacting the elected representatives The U.S. House and Senate have both reid.senate.gov. for your voting district. Keep reading to introduced bills to help fund Alzheimer’s Where funding is concerned, Al- find out more about what’s being done initiatives and to provide relief for care- zheimer’s research is being slashed. to address Alzheimer’s by your state and givers. The Bicameral Bipartisan Task President Bush’s 2009 budget proposal federal government officials—and what Force on Alzheimer’s Disease chairmen cuts include $11.4 million for State you can do to help ensure that memory Edward Markey (D-MA) and Chris Matching research grants, $1 million loss in America becomes just a memory. Smith (R-NJ) introduced the Ronald for the 24/7 Alzheimer’s Hotline, and Reagan Alzheimer’s Breakthrough Acts $940,000 for the MedicAlert® + Safe State Initiatives of 2004 and 2005 to the House of Rep- Return® programs. The CDC’s (Centers Legislation can var y dramatica lly from resentatives. Hillary Clinton (D-NY) for Disease Control and Prevention) state to state. According to the Fam- and Susan Collins (R-ME) are the chairs Alzheimer’s Brain Health Initiative ily Caregiver Alliance National Center from the Senate on the task force. Other will get $1.57 million in funding, but on Caregiving, the following states are leadership includes Senators Richard was cut by $300,000 from last year. the most recent to move forward on Burr (R-NC) and Barbara Mikulski Contact your congressional represen- Alzheimer’s-related legislation: (D-MD). Both bills died in commit- tative and your state’s two U.S. Senators • Arizona: A bill was passed to help edu- tee, but the Alzheimer’s Breakthrough today and inquire about their stances on cate respite and family caregivers who do Act of 2007 was introduced in March Alzheimer’s funding and legislation. not qualify for similar public programs. of 2007. It is currently still waiting to be • Illinois: This state’s legislature amend- heard by a House Committee. You can What’s Your Role? ed current legislation to allow family get task force updates by visiting chair- Every citizen has a right to petition members to be the designated paid man Ed Markey’s House webpage at his or her government. If you believe caregivers for other family members, http://markey.house.gov. Alzheimer’s legislation is an important with some strings attached, including In the Senate, S.B. 898 Alzheimer’s issue, you can write letters or e-mails, mandatory enrollment in Medicaid. Breakthrough Act of 2007, is on the cal- make phone calls, join an interest group, • Tennessee: An Alzheimer’s task force endar to be discussed by the Senate as a or just vote for Alzheimer’s-friendly poli- consisting of 14 members, including a whole. This act was introduced in August ticians. If you are an Alzheimer’s care- person with the disease and a caregiv- 2007 by Barbara Mikulski (D-MD). It giver, family member, or early-stage er, was established. They are required would amend the Public Health Service sufferer, you have a unique perspective to submit a state Alzheimer’s plan by Act to fund breakthroughs in Alzheim- to offer your representatives on Capitol February 15, 2009. er’s disease research while providing more Hill and in your state legislature. ■ 32 Preserving Your Memory summer 2008 Members of the Bicameral Bipartisan Task Force on Alzheimer’s Disease Check this list to see if your representative is on the Bicameral Bipartisan Task Force on Alzheimer’s Disease.

Alabama Florida Rep. Barney Frank Rep. Tim Bishop South Carolina Rep. Spencer Bachus Rep. Gus Bilirakis Rep. Stephen Lynch Rep. Joseph Crowley Rep. John Spratt Rep. Allen Boyd Rep. Ed Markey Rep. Eliot Engel Arizona Rep. Ander Crenshaw (Co-Chair) Rep. Maurice Hinchey Tennessee Rep. Raúl Grijalva Rep. Alcee Hastings Rep. Jim McGovern Rep. Steve Israel Rep. Lincoln Davis Rep. Ed Pastor Rep. Kendrick Meek Rep. Richard Neal Rep. Peter King Rep. John Duncan, Jr Rep. Rick Renzi Rep. Jeff Miller Rep. John Olver Rep. Nita Lowey Rep. Bart Gordon Rep. Adam Putnam Rep. John Tierney Rep. Carolyn Maloney Rep. Zach Wamp Arkansas Rep. Ileana Ros-Lehtinen Rep. Carolyn McCarthy Sen. Blanche Lincoln Rep. Robert Wexler Michigan Rep. Michael McNulty Texas Rep. Marion Berry Sen. Carl Levin Rep. Charles Rangel Rep. Lloyd Doggett Rep. John Boozman Georgia Sen. Debbie Stabenow Rep. Thomas Reynolds Rep. Charles Gonzalez Rep. Mike Ross Rep. Sanford Bishop Rep. David Camp Rep. Louise Slaughter Rep. Gene Green Rep. Vic Snyder Rep. John Lewis Rep. John Conyers Rep. Jim Walsh Rep. Silvestre Reyes Rep. Vernon Ehlers Rep. Anthony Weiner Rep. Pete Sessions California Guam Rep. Peter Hoekstra Sen. Barbara Boxer Del. Madeleine Bordallo Rep. Dale Kildee North Carolina U.S. Virgin Islands Rep. Xavier Becerra Rep. Sander Levin Rep. Bob Etheridge Del. Donna Christensen Rep. Howard Berman Hawaii Rep. Thaddeus McCotter Rep. David Price Rep. Brian Bilbray Rep. Neil Abercrombie Rep. Mike J. Rogers Utah Rep. Lois Capps Rep. Bart Stupak North Dakota Sen. Orrin Hatch Rep. Susan Davis Illinois Rep. Fred Upton Sen. Byron Dorgan Rep. Anna Eshoo Sen. Richard Durbin Vermont Rep. Sam Farr Rep. Danny Davis Minnesota Ohio Sen. Bernie Sanders Rep. Elton Gallegly Rep. Luis Gutierrez Rep. Collin Peterson Sen. Sherrod Brown Rep. Wally Herger Rep. Ray LaHood Rep. Jim Ramstad Rep. David Hobson Virginia Rep. Barbara Lee Rep. Jan Schakowsky Rep. Stephanie Tubbs Rep. Tom Davis Rep. Gary Miller Rep. Jerry Weller Mississippi Jones Rep. Randy Forbes Rep. George Miller Rep. Chip Pickering Rep. Marcy Kaptur Rep. Bob Goodlatte Rep. Grace Napolitano Iowa Rep. Dennis Kucinich Rep. James Moran Rep. Lucille Roybal- Rep. David Loebsack Missouri Rep. Steven LaTourette Rep. Frank Wolf Allard Rep. Jo Ann Emerson Rep. Patrick Tiberi Rep. Linda Sanchez Kansas Washington Rep. Loretta Sanchez Rep. Dennis Moore Nebraska Oklahoma Sen. Maria Cantwell Rep. Adam Schiff Rep. Jerry Moran Rep. Lee Terry Rep. Tom Cole Rep. Jay Inslee Rep. Hilda Solis Rep. Frank Lucas Rep. Rick Larsen Rep. Pete Stark Kentucky Nevada Rep. John Sullivan Rep. Jim McDermott Rep. Mike Thompson Rep. Ben Chandler Rep. Shelley Berkley Rep. Maxine Waters Oregon West Virginia Rep. Henry Waxman Louisiana New Jersey Rep. Peter DeFazio Rep. Shelly Moore Capito Rep. Lynn Woolsey Rep. William Jefferson Rep. Rob Andrews Rep. Alan Mollohan Rep. Rush Holt Pennsylvania Rep. Nick Rahall Colorado Maine Rep. Frank LoBiondo Rep. Jason Altimre Rep. Tom Tancredo Sen. Olympia Snowe Rep. Bill Pascrell Rep. Robert A. Brady Wisconsin Rep. Thomas Allen Rep. Donald Payne Rep. Christopher P. Sen. Russ Feingold Connecticut Rep. Michael H. Michaud Rep. Jim Saxton Carney Rep. Tammy Baldwin Rep. Rosa DeLauro Rep. Christopher Smith Rep. Mike Doyle Rep. Ron Kind Rep. John Larson Maryland (Co-Chair) Rep. Tim Holden Rep. Thomas Petri Rep. Chris Shays Sen. Barbara A. Mikulski Rep. Paul Kanjorski Rep. Elijah Cummings New Mexico Rep. John Murtha Note: List last verified in District of Columbia Rep. Wayne Gilchrest Rep. Tom Udall Rep. Joseph Pitts May 2008. Del. Eleanor Holmes Rep. Chris Van Hollen Norton Rep. Albert Wynn New York Rhode Island Sen. Hillary Rodham Rep. Patrick Kennedy Massachusetts Clinton (Co-Chair) Rep. James Langevin Rep. Michael Capuano Sen. Charles Schumer Rep. William Delahunt Rep. Gary Ackerman summer 2008 www.ALZinfo.org 33 Keeping Your Mind Sharp Brain-Boosting Puzzles BRAIN-BOOSTING CROSSWORDS “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  " "" " "" " #""" "  " " "" " "" " #""" "  " 
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34 Preserving Your Memory summer 2008 BRAIN-BOOSTING CROSSWORDS

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(Answers on page 37) summer 2008 www.ALZinfo.org 35 BRAIN-BOOSTING PUZZLES 
 
HIDDEN-MESSAGE WORD-FIND

All the words in the 
 
list, which are about superstitions, 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 by Oprah Winfrey. All the words in the list, which are about superstitions, can be foundYou in the are letter looking grid for reading a 44-letter across, phrase. up and down, and diagonally. When you have found them all, read the leftover letters to discover an apt quote by Oprah Winfrey. BLACK CAT LADDER PLUCTEALEAVESM You are looking for a 44-letter phrase. BLARNEYBLACK CAT STONE PENNYLADDER KEGNPLUCTEALEAVESM I ZEENSNP I R SSNACMAT EO I L EA BLUEBIRDBLARNEY STONE RABBIT’SPENNY FOOT KEGN I ZEENSNP I R DJSSNACMAT I NXUTETLAVTH EO I L EA BROKENBLUEBIRD MIRROR SEVENRABBIT’S FOOT TOELYRRSLDDJ I NXUTETLAVTH I DOC CHARMBROKEN MIRROR SILVERSEVEN DOLLAR AOOFVHYSDLPROATOELYRRSLD I DOC CRICKETCHARM SNEEZINGSILVER DOLLAR CREWTEAEEPSAOOFVHYSDLPROA I FL

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•VISIT US AT KAPPAPUZZLES.COM•

36 Preserving Your Memory summer 2008 PUZZLE ANSWERS BRAIN-BOOSTING PUZZLES HIDDEN-MESSAGE WORD-FIND            
 
 1e, 2g, 3a,    4j, 5c, 6l, 7d, 8k, 9f, 10h, J FK    CRASH CALM    CPA SLAT ASEA RAN T I NE 11b, 12i. ORAL LANCES CALM CPA SLAT 1e, 2g, 3a, 4j, 5c, 6l, 7d, 8k, 9f, 10h, J FK CRASH S I NGS I NG ENTS 
 
 GATE I GNORE ASEA RAN T I NE 11b, 12i. ORAL LANCES ENT I CE USAGES All the words in the list, which are about superstitions, can be found in the letter grid reading across, up and down, and S I NGS I NG ENTS STEVENSGATE I GNORE LOA CAD I TL L diagonally. When you have found them all, read the leftover letters to discover an apt quote by Oprah Winfrey. ENT I CE USAGES I NK ED I T PECAN ASA I DS   STEVENS LOA CAD I TL L All the words in the list, which are about superstitions, can be found in the letter grid reading across, up and down, and DOTE D I SC ECOL ACH TNUT You are looking for a 44-letter phrase. I NK ED I T PECAN ASA I DS diagonally. When you have found them all, read the leftover letters to discover an apt quote by Oprah Winfrey.   I OU EFT LEGGY Not many sounds in life exceed in PUNY VET ECOL ACH TNUT BLACK CAT LADDER PLUCTEALEAVESM DOTE D I SC SELF CAN interest a knock at the door. I LL MICHAEL I OU EFT LEGGY You are looking for a 44-letter phrase. Not many sounds in life exceed in PUNY VET J I CAMA ARAB I C SELF CAN interest a knock at the door. ELICITI LL MICHAEL ERIE ADOS BORABORA BLACK CAT LADDER KEGN I ZEENSNP I R J I CAMA ARAB I C BLARNEY STONE PENNY PLUCTEALEAVESM SENORA RANT GLUE LIP LIMA ELICIT ERIE ADOS BORABORA REPEL TEA SESS ELS ELAN SSNACMAT EO I L EA
  SENORA RANT GLUE LIP LIMA BLUEBIRDBLARNEY STONE RABBIT’SPENNY FOOT KEGN I ZEENSNP I R
  REPEL  TEA SESS ELS ELAN DJ I NXUTETLAVTH 1. Glue stick; 2. Paper clip; 3. Index SSNACMAT EO I L EA card; 4. Rubber band; 5. Letter opener; PLUCTEALEAVESM  243756891 BLUEBIRD RABBIT’S FOOT 1. Glue stick; 2. Paper clip; 3. Index KEGN I ZEENSNP I R BROKEN MIRROR SEVEN 6. Staple remover; 7. Postage stamp. TOELYRRSLD I DOC card; 4. Rubber band; 5. Letter opener; SSNACMATEOPLUCTEALEAVESM I LEA 816923457 DJ I NXUTETLAVTH KEGN I ZEENSNP I R 243756891 6. Staple remover; 7. Postage stamp. DJ I NXUTETLAVTH CHARMBROKEN MIRROR SILVERSEVEN DOLLAR TOELYRRSLDIDOCSSNACMATEO I LEA 759481326816923457 AOOFVHYSDLPROA DJ I NXUTETLAVTH TOELYRRSLD I DOC AOOFVHYSDLPROA 568179234759481326 CREWTEAEEPSTOELYRRSLDIDOC I FL CRICKETCHARM SNEEZINGSILVER DOLLAR CREWTEAEEPS I FL KRANNLRYREABSLAOOFVHYSDLPROA 371842569568179234 AOOFVHYSDLPROA     CREWTEAEEPS I FL CT I RTOEDS I OETE 924635718371842569 ANACSMKHOEEUKRANNLRYREABSL I R CRICKET SNEEZING KRANNLRYREABSL Luck is a     matter of preparation meeting CT I RTOEDS I OETE CURSE SPILL SALT CREWTEAEEPS I FL LLT I KEOCNLGLBB 682394175924635718 opportunity. ANACSMKHOEEU I R Luck is a matter of preparation meeting BOPPOEVROT LBBM 495217683682394175 CT I RTOEDS I OETE UNTHLLT I KEOCNLGLBBI RTEEN I AAU EVILCURSE EYE TEASPILL LEAVES SALT KRANNLRYREABSL opportunity. TYRORRBOPPOEVROT I MNEKORB LBBM 137568942495217683 UNTH I RTEEN I AAU ANACSMKHOEEUCT I RTOEDS I OETE I R TYRORR I MNEKORB 137568942 HORSESHOEEVIL EYE THIRTEENTEA LEAVES LLTANACSMKHOEEU I KEOCNLGLBB I R YOU CAN MAKE A DIFFERENCE! INHORSESHOE THREES UMBRELLATHIRTEEN BOPPOEVROTLBBMLLT I KEOCNLGLBB Now here is how you can do your part to support the cause to find a cure! IN THREES UMBRELLA JINX UNTHBOPPOEVROTLBBM I RTEEN I AAU Subscribe to one of these magazines, and a percentage of the proceeds will go to the Fisher Center for Alzheimer’s Research Foundation. KNOCKJINX ON WOOD TYRORRUNTH I RTEEN I MNEKORB I AAU Send this money-saving coupon and payment to: KAPPA PUBLISHING GROUP, INC. • PO Box 657 • Mt. Morris, IL 61054-0657 KNOCK ON WOOD  TYRORR I MNEKORB 1 year 2 years BLUE RIBBON CROSSWORDS SPECIAL ■ (12 ISSUES) ■ (24 ISSUES) To complete each puzzle below, fill in the squaresSUDOKU so that each digit 1 through 9 will appear exactly once in (JBXS) $37.00 $71.00 each row, in each column, and in each enclosed  nine-unit block. BLUE RIBBON SUDOKU PUZZLES (JBRS) ■ $28.30 (12 ISSUES) ■ $53.80 (24 ISSUES) To complete each 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. NAME ______4 6 9 TOTAL PAYMENT ENCLOSED 1 3 7 ADDRESS ______4 6 9 $______CITY ______STATE ______ZIP ______19 332 7 CANADIAN FUNDS ACCEPTED 5 9 7 232 4 E-MAIL ADDRESS: ______■ VISA ■ MASTERCARD # ______5 8 72 2 4 9 4 3 8 Expiration date: ____ / ____ Signature ______8 2 MO YR ■ Check or Money order (Payable to KAPPA PUBLISHING GROUP, INC.) 982 4 3 1 8

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summer 2008 www.ALZinfo.org 37 (continued from page 9) Dr. Paul Greengard Director of the Fisher PYM: Do natural remedies (e.g., Omega-3 fatty acids, Center for Alzheimer’s ginkgo biloba, curry) hold promise for the prevention of Disease Research at The Alzheimer’s disease? Rockefeller University Dr. Paul Greengard Dr. Greengard: The evidence here is conflicting. For was awarded the year example, there is evidence that DHA or other omega-3 2000 Nobel Prize in fatty acids may help reduce the risk of Alzheimer’s. Some Physiology or Medicine evidence suggests that curcumin (a derivative of the Indian for his pioneering work in curry spice turmeric) may also reduce Alzheimer’s risk. delineating how neurons Most of this evidence is derived from retrospective studies communicate with one and are based on correlations. These are not the most another in the brain. reliable kinds of studies. Instead, well-controlled tests on During a half-century Photo: Josh Wolff large groups of people need to be carried out first to assess of research, he has been the value of these substances. In fact, a large well-controlled lauded for his singular contribution to our understanding clinical trial that tested the ability of ginkgo biloba to of the complex signaling processes that occur within reduce the risk of Alzheimer’s has recently been completed. each of the 100 billion or more nerve cells in the human The results of that trial could be announced in the next brain. He is the Vincent Astor Professor at The Rockefeller several weeks. ■ University and Director of the Fisher Center laboratory. Dr. Greengard is also a member of the National Academy of For more information from Dr. Greengard, please visit: Sciences and has received more than 50 awards and honors www.ALZinfo.org. throughout his career. He is the author of nearly 1,000 scientific publications. For up-to-date information on clinical trials currently underway, please visit: www.clinicaltrials.gov.

Medicinal Laughter Agnes

38 Preserving Your Memory summer 2008 ALZinfo.org

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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Sign up to receive Alzheimer’s e-mail alerts right to your inbox. summer 2008 www.ALZinfo.org 39 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 AMEMORY. FOR EVERYONE. Donate now for the cure. ALZINFO.ORG 1-800-ALZ-INFO

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