Memorypreserving your Spring 2013 The Magazine of Health and Hope

Penny Marshall A Second Opinion Talks About Her Mom When It’s Time to Get One and Her New Book A New Approach to Caregiving The latest news on Alzheimer’s research and treatment

Features

One Intrepid Square West 46th Street & 12th Avenue New York, NY 10036 1-800-ALZ-INFO www.ALZinfo.org

Kent L. Karosen, Publisher Betsey Odell, Editor in Chief Alan White, Managing Editor William J. Netzer, Ph.D., Science Editor Jerry Louis, Graphic Designer Toby Bilanow, Bernard A. Krooks, Contributing Writers 18

8 Clothes Encounters Discover some simple solutions to your loved one’s clothing needs. 12 Reaching Out to Caregivers A new book explores innovative ways for caregivers to reach out to their loved ones. Preserving Your Memory is published by 14 MetLife Foundation Creative Libraries Krames StayWell Project Expands 407 Norwalk St., Greensboro, NC 27407 A community library-based program for older (336) 547-8970 Americans is a booming success. Sam Gaines, Managing Editor Traci S. Cossman, Design Manager 18 A Penny for Her Thoughts: An Judy Nance, Account Manager Interview with Penny Marshall Jan McLean, Creative Director The actor and director talks about her mother and Traci Marsh, Production Director Selby Bateman, Kevin Gault, Cari Jackson, Dianne Orlando, her new book. Tamekia Reece, Jennifer Sellers, Mary Adam Thomas, Winnie Yu, Contributing Writers 27 The First Rule on Second Opinions Find out when and why you should seek a second Cover photo: Penny Marshall’s personal collection opinion following an Alzheimer’s diagnosis. Made possible by a grant from 30 Hitting the Target Researchers are working on new ideas for finding effective treatments—and even a cure—for A leader in finding an Alzheimer’s cure Alzheimer’s disease. Contents

5 From the Editor’s Desk Spring is here again! 6 News Briefs Read the latest news on Alzheimer’s disease and brain health. Board of Trustees 8 Clothes Encounters Zachary Fisher, Founder (1910-1999) Barry R. Sloane, Chairman 10 Caregiver Voices Martin Edelman, Howard Lutnick, Vice Chairmen A caregiver shares her heart in verse. Kent L. Karosen, President and CEO 11 Fisher Center Research Bill White, Secretary We talk to Jean-Pierre Roussarie, Ph.D., about Barry R. Sloane, Treasurer his work in Alzheimer’s research in the Fisher Dr. Manny Alvarez James L. Nederlander, Jr. Center laboratory. Dr. E. Ratcliffe Anderson, Jr. Murray Rubin Gerry Byrne Richard J. Salem 12 Reaching Out to Caregivers Hadley Fisher Dr. Moshe Shike Hon. Betsy Gotbaum David H.W. Turner 14 MetLife Foundation Creative Dr. Paul Greengard Libraries Project Expands Scientific Advisory Board Dr. William Netzer, Chairman Dr. Sangram Sisodia 18 A Penny for Her Thoughts: An Dr. Floyd Bloom Dr. Rudolph Tanzi Interview with Penny Marshall Dr. Carl Cotman Dr. Lars Terenius 22 Fitness Dr. Donald Price Learn some simple exercises to strengthen your core. For advertising information, please contact: Betsey Odell Erin McCarthy Fisher Center Foundation Krames StayWell 24 Food: Vitamin D and Your Brain (646) 381-5148 (336) 547-8970, ext. 3327 This important vitamin has a powerful role to play in your brain’s health. Plus, try this delicious vitamin D-loaded tuna recipe. Snap a photo of this QR code* 27 The First Rule on Second to get more information about Alzheimer’s disease! Opinions *Download a free code reader app for your 30 Hitting the Target smartphone at your phone’s marketplace

32 Long-Term Planning © Copyright 2013 by the Fisher Center for Alzheimer’s Research Foundation. No part of this publication may be reproduced or transmitted in any form or by Here’s what you need to consider before any means without written permission from the Fisher Center for Alzheimer’s Research Foundation. Articles in this publication are written by professional preparing a will. journalists who strive to present reliable, up-to-date health information. However, personal decisions regarding health, finance, exercise, and other 34 Keeping Your Mind Sharp matters should be made only after consultation with the reader’s physician or professional adviser. All editorial rights reserved. Opinions expressed herein are Give your brain a workout with these brainteasers. not necessarily those of the Fisher Center for Alzheimer’s Research Foundation. From the Editor’s Desk

A Breath of Fresh Air

he days are getting longer, and the weather is just starting to warm up a bit. We hope this issue of Preserving Your Memory has arrived in time to help you T celebrate spring. Our cover story is a chat with writer/director/actor Penny Marshall about her mom and her new book (page 18). We also talked with Maura O’Malley of Lifetime Arts about the innovative MetLife Foundation Creative Aging Libraries Project, which entered its second phase in December 2012 (page 14). Tom and Karen Brenner have authored a new book detailing their work with Alzheimer’s and dementia patients, and its full of ideas for caregivers seeking to reach their loved ones (page 12). And for those whose loved ones have received an Betsey Odell Alzheimer’s diagnosis, we look at the importance of getting a second opinion when called for (page 27). On the research front, we talk to Fisher Center scientist Jean-Pierre Roussarie about his work in Alzheimer’s research (page 11). And we learn about current directions in the search for better Alzheimer’s drug treatments (page 30). We hope this issue of Preserving Your Memory is a breath of fresh air for you.

Betsey Odell Editor in Chief

Please send your tips, stories or questions to the Fisher Center for Alzheimer’s Research Foundation, One Intrepid Square, West 46th St. & 12th Ave., New York, NY 10036, or by e-mail to [email protected].

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 one of the world’s largest research teams 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. Oprah’s O Magazine listed us as the top charity to give to for Alzheimer’s. The Fisher Center Foundation has earned Charity Navigator’s highest 4-Star rating for fiscal management and commitment to accountability and transparency. For more information or to make a donation, go to www.ALZinfo.org. spring 2013 www.ALZinfo.org 5 News Briefs

The Latest News on Alzheimer’s Disease and Brain Health

U.S. Lagging Behind in Alzheimer’s Support A report from the U.S. Senate Special Committee on Aging found that among five nations, the U.S. is falling behind in supporting the growing number of people with Alzheimer’s disease and other forms of dementia. Notable among the five nations— France, Japan, Australia, Great Britain and the U.S.—France is now implement- ing its third plan to address Alzheimer’s as The U.S. lags behind France and other a nation. The U.S. issued its first plan in countries in Alzheimer’s support. May 2012. The report examines trends that are currently under way in all five coun- tries. These trends include coordinat- ing research more effectively, diagnosing Alzheimer’s more reliably and improv- The drug, solanezumab, was tar- Ricks, a senior vice president at Lilly ing training in dementia care by medical geted at people with mild to moderate and president of Lilly Bio-Medicines, practitioners. Among the issues examined Alzheimer’s disease, but failed to sig- said in a statement. “We are committed is the degree to which home-care services nificantly improve cognition or daily to working with the F.D.A. and other are available to people with Alzheimer’s or functioning of people with mild to regulatory authorities to bring solan- other forms of dementia. moderate Alzheimer’s in previous ezumab to the millions of patients and The U.S. lags behind the others in research. But the drug did show promise caregivers suffering from this devastat- paid long-term care support for people in improving the cognition of people ing disease who urgently need this over age 65; home-based care provided with mild Alzheimer’s when they were potential treatment.” for people over age 65; and the amount separated out from the larger study results. Dr. Reisa Sperling, professor of neurol- of hours of unpaid care provided by The new study, which will begin in ogy at Harvard University, is leading the family caregivers. the third quarter of 2013, will look more trial. She says her team hopes to find that closely at how the drug affects people solanezumab will slow memory decline with mild Alzheimer’s. The drug targets by as much as 30 percent. Alzheimer’s Drug to Be beta amyloid, a protein found in the brain Studied Again of people with Alzheimer’s. The study An experimental drug from phar- will focus on 1,000 people age 70 to 85 New Research Points to maceutical company Eli Lilly that had who have varying levels of beta amyloid Possible Alzheimer’s Vaccine mixed results in previous trials will be in their brains. A Canadian research team from Uni- studied anew, according to a company “We remain encouraged and excit- versité Laval and CHU de Québec, along spokesperson. ed by the solanezumab data,” David with pharmaceutical firm GlaxoSmith-

6 Preserving Your Memory spring 2013 Kline (GSK), has found a way to stimu- nitively fit people, were tested on their late the brain’s natural defense mecha- ability to process semantic information. nisms in people with Alzheimer’s disease. The tests involved determining which The breakthrough discovery could lead of two objects, such as an ant and a the way to a treatment for Alzheimer’s house, was larger. The study found that and even a vaccine to prevent the disease. people with MCI or Alzheimer’s had a The researchers identified a molecule harder time telling which of the objects called monophosphoryl lipid A (MPL), was larger when the two objects were which stimulates the activity of the brain’s depicted at a similar size. immune cells. When injected into mice “This finding suggested that semantic with Alzheimer’s symptoms over a period processing was corrupted,” said Dr. Terry of 12 weeks, up to 80% of beta-amyloid Goldberg, Ph.D., a professor of psychia- plaques in the mice brains were eliminated. try and behavioral science at the Hofs- Beta amyloid has been closely associated tra North Shore-LIJ School of Medicine with the development of Alzheimer’s dis- and Director of Neurocognition at the ease. When tested over the same period, Litwin Zucker Center for Research in the MPL-treated mice showed significant Alzheimer’s Disease and Memory Disor- cognitive improvement. A breakthrough discovery could ders at The Feinstein Institute for Medical “When our team started working on lead to an Alzheimer’s vaccine. Research in Manhasset, N.Y. “MCI and Alzheimer’s disease a decade ago, our AD (Alzheimer’s disease) patients are really goal was to develop better treatment for termeasures and to determine the risks to affected when they are asked to respond Alzheimer’s patients,” explained team lead- astronauts of extended space travel. to a task with small size differences.” er Dr. Serge Rivest, professor at Université “Galactic cosmic radiation poses a sig- Laval’s Faculty of Medicine and research- nificant threat to future astronauts,” said er at the CHU de Québec research center. Michael O’Banion, a professor at the Deep-Brain Stimulation “With the discovery announced today, I University of Rochester Medical Center Shows Promise think we’re close to our objective.” and senior author of the study, which was Using deep-brain stimulation via a published in the scientific journal Plos pacemaker-like device implanted in the One. “This study shows for the first time brain can help improve the symptoms Space Travel Could Worsen that exposure to radiation levels equiva- of Alzheimer’s disease, scientists have Alzheimer’s, Study Finds lent to a mission to Mars could produce learned in a pilot study. A NASA-funded study of lab mice cognitive problems and speed up chang- Researchers at Johns Hopkins Univer- found that the radiation one is ex- es in the brain that are associated with sity found that six patients who were posed to in space might harm the brain Alzheimer’s disease.” tested showed slight improvement in and accelerate the development of memory and a slower decline in cognitive Alzheimer’s disease. function after deep-brain stimulation. In the study, lab mice were bombarded Study: People with MCI PET scans of the test subjects’ brains with varying doses of radiation equivalent Have Trouble Processing showed slightly improved glucose con- to what they would encounter in space Information sumption in the brain, which is a posi- travel, including on a mission to Mars. It is well known that many people tive sign. Glucose consumption decreases After exposure, the mice were tested who have mild cognitive impairment in the areas of the brain that Alzheimer’s for their ability to recall certain objects (MCI), which can be an early stage disease affects. or locations. Mice exposed to radiation of Alzheimer’s disease, have short- Deep-brain stimulation could open a were far more likely to fail those tasks, term memory problems. A new study new door to treating Alzheimer’s disease researchers found. focused on people with MCI who should further testing with larger num- NASA is currently planning a mission have trouble processing semantics and bers of patients show that it is useful. ■ to an asteroid in 2021 and to Mars in 2035. knowledge-based information. The agency has been funding research into In this study, published in the Amer- Check the Fisher Center website the effects of cosmic radiation over the ican Journal of Psychiatry, people with (www.ALZinfo.org) often for up-to-date past 25 years in order to develop coun- MCI and Alzheimer’s, along with cog- and expert-reviewed scientific news. spring 2013 www.ALZinfo.org 7 By Jennifer Sellers Clothes Encounters Here are some simple solutions for dealing with your loved one’s dressing and wardrobe needs.

icture a woman who is a serious clotheshorse. She allow him or her to select daily outfits. This action can spends a great deal of time building her wardrobe, promote self-esteem and allow the person with dementia to P finding just the right pieces. She then carefully still feel a sense of control over his or her own life. plans out each day’s outfit, matching different looks As the disease progresses, wardrobe selection can become and colors for optimal stylish impact. These day-to-day more overwhelming. You can help reduce the confusion experiences with clothing and accessories are positive, even associated with this task with a good spring-cleaning of enjoyable for her. your loved one’s closet and drawers. Now imagine this same woman several decades later. She Your first step in the process should be to remove any has Alzheimer’s disease, and opening the door to a closet unnecessary clothing. In the beginning, go ahead and get full of clothing—an activity she once found pleasurable— rid of anything your loved one no longer wears. You can fills her with anxiety. The vast number of choices makes pare down the clothing selection even further by keeping selecting an outfit overwhelming. And once she does off-season clothing in a different closet. manage to stumble upon a suitable article or two, dressing As you organize, it’s also helpful to categorize items— presents an entirely new set of challenges. Her daughter, shirts with shirts, pants with pants, and so on. A helpful who is also her caregiver, is equally exasperated by the way to assist your loved one in remembering which drawers experience. to use is to cut out a magazine or catalog picture of certain This hypothetical scenario represents what many categories of clothing and then tape those pictures to the Alzheimer’s caregivers and their loved ones go through on corresponding drawers. For example, tape a picture of a a daily basis, says Brittany Barnet, a certified dementia nightgown to a drawer containing sleepwear. care professional, and president of Healthcare Products, Once the Alzheimer’s disease has reached a moderate LLC. “Dressing poses a series of challenges for someone stage, you will want to limit your loved one’s choices even who has Alzheimer’s disease,” she says. “Obstacles include further, and eventually get more involved in helping him choosing what to wear, getting clothes on and off easily, or her select clothing. Perhaps at this point, you can lay and struggling with zippers and buttons. It’s important to out two outfits for your loved one each day, and then let minimize these challenges for both the individual and the him or her choose what to wear from that small selection. caregiver.” According to Barnet, this will still allow your loved one Thankfully, there are ways to make the processes of some autonomy, while making the decision process easier clothing selection and dressing easier on both parties. Here and less stressful. are some tips recommended by eldercare experts: When it comes to advanced Alzheimer’s disease, it might be wise to limit your loved one’s clothing choices Organize Your Loved One’s Closet altogether. Removing most or all of the stored clothing and Drawers from the dressers and closets in his or her immediate living Organization is an important first step. If your loved one area may be a necessary step to prevent confusion and is still in the early stage of Alzheimer’s disease, you should distress.

8 Preserving Your Memory spring 2013 Hygiene Matters Because dressing is often such a challenging event, it may be tempting at times to let your loved one go a day or two without changing clothes. Avoid this if at all possible. Changing is necessary for optimal personal hygiene. Where undergarments are concerned, frequent changing helps prevent urinary tract and other infections.

Looking for Clothing Designed Specifically for People with Dementia? Visit The Alzheimer’s Store at: www.alzstore.com

Bath capes and non-slip shoes can be helpful for Alzheimer’s patients.

Select Alzheimer’s-Friendly Clothing Making sure your loved one has appropriate clothing may mean getting rid of some of his or her existing wardrobe. It might also require buying new clothing. Here are some tips that will help you make the right selections: • Opt for tops that fasten in the front rather than pull over the head. • Look for shirts, sweaters and jackets with Velcro fasteners. If you are unable to find any, you can add the fasteners to existing clothing items (or have a tailor or seamstress do so). • Choose clothing that is loose-fitting and stretchable. • Ensure that socks are snug, but not tight, and of the “no-skid” variety. • Buy non-slip shoes that don’t have laces. • Stock up on duplicates of wardrobe items your loved one likes to wear repeatedly. • Lean toward durable fabrics, and avoid clothing with special washing requirements. • Consider clothing that fastens in the back if your loved one has a problem with repeated disrobing. • Don’t forget other specific doctor-recommended clothing—such as circulation-enhancing socks or diabetic shoes—your loved one may need. (continued on page 38) spring 2013 www.ALZinfo.org 9 Caregiver Voices By Dianne Orlando A Moment in Time

have a sister whom I love with all my heart and I have a I would like to say to all of my nieces and nephews up in best friend whose mother, whom I love with all my heart, Newfoundland, who are tirelessly caring for my big sister, I are both suffering with the insidious disease that has a few “thank you” from the bottom of my heart and please “stay different labels. Whether you call it Alzheimer’s or dementia, the course”—I know how much you all love her and she is so as you all know it steals your memory, and you feel that you special. To my friend Lina I would like to say, you are such an lose those precious people in your life long before you lose incredible daughter to your mom. So few people in life give to them to death. I wrote this poem in their honor, and in honor a parent as you do, “stay the course”—she is so special. And of all the brave families out there who are losing their loved for anyone out there who is caring for a loved one with this ones to this horrible disease. I am sure you will recognize in it illness or any other, “stay the course,” as I am sure your loved a “moment” that you have had. one is special!

A Moment You called me by my name today Your eyes were clear as a star-filled sky My heart was filled with dismay What made today different from all the days gone by You said, “I love you” today The joy I felt was sublime “Mamma,” I replied, once again you are mine What made today different from all the days gone by Today I caught a glimpse of all your yesteryears When everyone knew your name And were addicted to your fame When you were sought after For your special brand of laughter What made today different from all the days gone by As I look eagerly into your face Wanting more and more of your good grace I see the clouds begin again The blankness that has become familiar Swooping down in fear and anger Robbing you of you Robbing me of you Robbing the world Of all your splendor What made today different from all the days gone by Today, I received a gift And that gift was a moment, just a whisper of a moment With my mamma!

10 Preserving Your Memory spring 2013 Research

News from the Fisher Center for Alzheimer’s Research Preserving Your Memory talked to Dr. Jean-Pierre Roussarie, postdoctoral associate at the Fisher Center for Alzheimer’s Disease Research Laboratory, about the work they are doing there now.

Preserving Your Memory: Please the Greengard lab has been developing for tell me about the research you’re many years. They allow us to manipulate currently doing in Dr. Greengard’s the quantity of proteins in the brain of lab. What is the nature of the an animal model in any region we want research? What are you targeting? to study. We plan to change the levels of proteins we have associated with vulner- Dr. Jean-Pierre Roussarie: My ability to see if brain cells become more or approach is slightly different from the less protected in different animal models usual ones. I am trying to understand of AD. These two approaches will tell us why certain brain regions are hit harder which proteins are the most important for than others by Alzheimer’s disease (AD). protecting or harming brain cells in AD. In other words, what makes the brain re- The proteins are likely to become very gion that controls the formation of recent promising new therapeutic targets. memories more vulnerable than other Dr. Jean-Pierre Roussarie brain regions in Alzheimer’s disease, and PYM: What impact might your how can we protect these vulnerable brain small number of proteins that are present work have on Alzheimer’s diag- regions from the ravages of this disease? only in vulnerable regions and not in resis- nosis or treatment in the future? tant regions, as well as proteins present in PYM: If you had to sum up your resistant regions but not in vulnerable re- Dr. Roussarie: The ultimate goal of work in a few sentences, what gions. We are now investigating whether our work is to be able to prevent vul- would you say? these proteins indeed play a major role in nerable cells from degenerating. If we causing vulnerability or resistance. We have find compounds that protect vulnerable Dr. Roussarie: It is clearly not the two approaches. The genetic approach, for cells, we could manage to stop the pro- whole brain that is affected by AD. At which we are collaborating with the re- gression of Alzheimer’s symptoms if we early stages, only regions involved in nowned Alzheimer’s geneticist Rudy Tanzi, treat patients very early on with these the formation of new memories stop is to learn if Alzheimer’s patients have muta- compounds. functioning while the rest of the brain tions in any of the proteins we have identi- remains normal. To understand why fied. If such mutations were associated with PYM: What directions can you these regions are particularly vulnerable, increased risk for developing Alzheimer’s see your work taking from here? we are comparing all the proteins present disease, this information would make us in vulnerable regions to those present in more confident that the mutated protein Dr. Roussarie: We still need to refine resistant regions so that we can pinpoint causes the brain cells in that region to be our understanding of the vulnerability proteins that cause the vulnerability and more vulnerable to Alzheimer’s disease. We of specific brain regions in Alzheimer’s proteins that cause resistance. already have one promising candidate pro- disease. Once we find the proteins tein that is present at much higher levels in responsible for vulnerability, the next step PYM: What have you learned thus resistant brain regions. We recently discov- is to find drugs that target these proteins. far from your research? ered that certain mutations in this protein Given the decades of experience of the are associated with the risk of getting AD. Greengard lab and the great expertise of Dr. Roussarie: We have made a lot of Our other approach is to use animal its scientists, I am very hopeful that we progress. We were able to identify a very models. We use the really great tools that will achieve our goals. ■

spring 2013 www.ALZinfo.org 11 By Sam Gaines Reaching Out to Caregivers A new book aims to help dementia caregivers connect with their loved ones—in sometimes surprising ways.

aregiving for a person with dementia or Alzheimer’s In their many years of experience working with elder-care disease can be fraught with frustration, but it also can facilities and memory enhancement centers, the Brenners C be rewarding in ways that may surprise a caregiver. came to see that applying Montessori methods could achieve Getting to those rewarding moments is the subject of You breakthroughs with people with dementia, as well. “Through Say Goodbye and We Say Hello, a new book by husband-and- it all, Karen and I believe that one of the fundamental wife team Tom and Karen Brenner. The Brenners—Tom aspects of this process is that learning never ends,” says Tom. is a gerontologist, trainer, and researcher in the caregiving “To a lot of people who have worked in the dementia field, it field, while Karen is an experienced Montessori educator is an earth-shattering concept when you give them the news who now works with Tom on Brenner Pathways, the couple’s that people with dementia can still learn.” business—have been featured speakers at conferences on And learn they do. Throughout You Say Goodbye and We aging for years. Say Hello, the Brenners document astounding instances In fact, the book emerged from a frequent request the in which using or adapting a Montessori tool led to a couple heard at the conferences where they spoke. “Often moment of real connection with a person with dementia at these talks, people would come up to ask, ‘Where can or Alzheimer’s. In one case, Tom and Karen encountered we buy your book?’” says Karen. “A few years ago, one of a man who had been a farmer and who had advanced the attendees asked us, ‘Don’t you think you owe it to the dementia. He and his brother had both been placed in the aging community to write a book?’ So we were encouraged memory enhancement center and they could no longer to write it down.” handle farming duties. “So I was thinking, how can I What they wrote down is a wealth of real-world engage people who have this interest?” Tom recalls. He experiences where they have been able to reach dementia obtained some tractor pictures, had them laminated, and patients by applying Montessori methods to their work. simply asked the gentleman, “Would you like to look at The Montessori Method refers to the work and philosophy some tractors with me?” The man agreed. They came upon of Maria Montessori, an Italian physician and educator one picture that showed the tractor in high grass. Tom from the late 19th and early to mid-20th centuries whose said it looked broken, but the man gently corrected him. pioneering work with disadvantaged children opened “‘Young man, listen: That tractor ain’t broken. It’s just been the door to a more humane, compassionate approach to parked in high grass. Sometimes you have to look deeper.’ childhood education. Montessori developed the use of Truly, that has become a core principle of our work.” child-sized furniture and child-appropriate educational Another core principle of the Brenners’ work and materials to reach children previously thought unreachable, the book is to meet people where they are, without and her philosophy embraced the encouragement of self- expectations. “People with dementia are not the walking discipline and self-inspired achievement. The results were dead, being in a relationship with someone who happens so successful that her methods have been used around the to have this condition is not just one long goodbye,” the world in all types of schools (including Montessori schools) Brenners write. “We have to find a new way to say hello; it to help children succeed in learning. is our job to find a way to be in relationships.” Part of that

12 Preserving Your Memory spring 2013 Tom and Karen Brenner and their new book, You Say Goodbye and We Say Hello. process is using positive language in talking with caregivers and people with dementia. “We believe that being a caregiver is an opportunity to be more than we thought we could be,” says Tom. “We fully realize how demanding, exhausting, and heartbreaking this work can be. However, if we can get caregivers to think outline in the book. “Moments when patients are sharing in a more positive way about the work they’re doing, this their stories are moments when they are present with us. can transform their caregiving role and how they feel about These moments, no matter how brief or how fleeting, what they do.” can be times of great meaning and wonderful, deeply felt Another key point the Brenners make in the book is connection,” the Brenners write. “It is these moments of the importance of what is called “procedural memory,” soul-to-soul connection that are captured in the stories that or “muscle memory,” in connecting with people with people tell us. It is through these stories that the spirit of dementia. This can be seen when a natural object is placed the people we meet in our work comes shining through the in the hands of a person with dementia. In one instance, fog of dementia.” Tom brought some old hubcaps with him to a center, where You Say Goodbye and We Say Hello is an inspiring, eye- he invited one man to polish hubcaps with him (using opening look into how using The Montessori Method and non-toxic polish). “This guy starts telling me war stories creating a positive environment can deepen the connection from Vietnam, like he’s sitting [on] the footlocker in the between caregivers and the people they love. barracks, talking to another GI—he’s back polishing his boots, or his brass, and we’re talking war stories. I was You Say Goodbye and We Say Hello is available through really astonished!” Amazon.com and as an iBook through the Apple Store. You can Storytelling (as well as reciting poetry and sharing jokes) learn more about Brenner Pathways at their website, is another important piece of the Brenners’ work, as they www.brennerpathways.org. ■

spring 2013 www.ALZinfo.org 13 MetLife Foundation Creative Aging Libraries Project Expands

program aimed at engaging older Americans with Maura O’Malley: It happened initially because the arts in public libraries that began in New York MetLife Foundation supported pilots in three cities—Miami, A has now rolled out to 18 public libraries in Boston, Dallas, and Boston. MetLife Foundation had been paying Dallas and Miami, thanks to continued support from attention to our work in New York City, which had received MetLife Foundation. national attention because it demonstrates that active, engaged The MetLife Foundation Creative Aging Libraries Project learning in the arts has significant benefits for older adult is designed and administered by New Rochelle, New York- participants—and because it provides new programming for based Lifetime Arts, Inc. This second phase of the project public libraries — helping them to respond to the growing began in December 2012 and continues through this demand for meaningful programs for today’s older adults spring. The project connects professional teaching artists (55+). MetLife Foundation wanted to bring the work out with older adults in free instructional arts workshops (in all beyond New York City, and now we’ve rolled out to 18 disciplines) held at public libraries. The project is designed to libraries in three cities. In each of those cities we trained artists foster mastery and promote meaningful social engagement, and library personnel. The libraries were chosen because of considered two key ingredients for positive aging. their interest in serving older adults, demographics, and other “With this new set of creative aging programs, MetLife factors, such as the strength of their arts communities. These Foundation is helping us share Lifetime Arts’ successful programs are getting under way shortly and throughout the program model with major library systems beyond New spring. They run the gamut, all disciplines. The projects have York and helping shift ‘senior’ programming from passive been enthusiastically received and endorsed. It’s fun working entertainment to engaged learning,” says Ed Friedman, with the different cities. The Institute for Museum and Executive Director of Lifetime Arts. Library Services (the federal agency that oversees libraries from We spoke with Lifetime Arts President and CEO Maura a federal level) is encouraging us to roll this out more broadly, O’Malley about this new phase of the project and the so we’re currently writing a proposal to expand our work out broader implications of positive aging nationwide. to 18 more library systems across the country. Right now we’re in the midst of a two-year pilot. We’ve been encouraged by all Preserving Your Memory: When we of our partners to roll this out in a sort of national expansion last spoke, you mentioned that the to create an affiliate group of libraries, and we’ll work with MetLife Foundation Creative Aging them over the next 3 years to help them build their capacity Libraries Project would roll out to to do this work, including professional training, access to libraries beyond New York State. resources, etc. With the American Library Association we’re That has now happened. How did it currently developing an online toolkit that we’ll have ready happen? by June 2013, which will provide information, templates,

14 Preserving Your Memory spring 2013 Photo: LifetimePhoto: Arts Photo: LifetimePhoto: Arts The MetLife Foundation Creative Aging Libraries Project embraces all artistic disciplines. Photo: LifetimePhoto: Arts Photo: HerbPhoto: Scher

etc., to librarians across the country. So this is becoming very as people age, this sort of natural aging process, people rapidly a national initiative. Our role in helping build this experience a series of losses—they stop working, people move is becoming more prominent, too. AARP Foundation has away, kids leave home, sometimes they lose a spouse. So taken notice of the work and they’re supporting the libraries making connections is critical, and these projects where people project, and they’re taking a look at this work because it is come together around learning are extremely potent vehicles effective in combating isolation among older adults. In a series for helping people connect in new ways to other people and of 8-10 weeks, people come together around the learning to their own lives. In every case, people have had amazing facilitated by a professional teaching artist, and these artists things happen. People are learning new things and sharing are able to create an environment where adults can learn new them. Every project culminates with a public sharing of some skills and build community. These projects have all been kind—a performance, or an art show, etc. So it begins to shift unique, every library program is unique because the adults the way people think about aging, away from the negative who come to them are unique, as well as the teaching artists view of aging to a positive view, one where life is ripe with who conduct the programs. Public libraries are free and open opportunity and challenge and engagement. So all this kind to the public, welcoming to older adults. People can take risks of resonates with lots of different people, everyone in this around learning, they’re encouraged, and their achievements age range, 55 and up, up to 95 and 98 years old. All kinds are honored and shared. They have an enormous impact on of people are all the sudden unleashed and able to express people’s lives. themselves. We’re all in this same club, we’re all headed in One example: In one of the culminating events of a choral this direction, and even now we have elderly parents, or we’re ensemble program, two people announced their engagement. boomers and getting there ourselves. The teaching artists find a new way of thinking about what it means to age, and what it Preserving Your Memory: The means to learn and be a community. project promotes mastery of an art form as well as meaningful social Preserving Your Memory: What sort engagement for its participants. Why of feedback are you getting from the are these facets so important to librarians, artists and participants? project participants? Maura O’Malley: Overwhelmingly positive. It’s Maura O’Malley: By this we mean learning new our mission to continue bringing together all the partners things, and making new friends. Part of the idea is that to make this kind of work happen. Arts education,

spring 2013 www.ALZinfo.org 15 People connect to form communities around shared artistic experiences.

library services, cultural institutions—all these come together in this work to make the projects happen. So it’s Photos: Herb Scher continuing to expand and grow. We’re also partnering with artists and the participants there with them, as well as the American Library Association and Temple University’s homebound people via the Internet. Organizations and Intergenerational Institute. agencies are excited about the opportunities to partner, and we’re finding that people have the same goals: improving the Preserving Your Memory: What quality of life for older adults, increasing the importance of is required for libraries across public libraries as community institutions. the nation to develop their own programs? What resources are Preserving Your Memory: Ultimately, available to them? what would you like to see in terms of spreading the Creative Aging Maura O’Malley: We’re developing a training Libraries Project to more libraries? curriculum that will roll out over the next three years that includes everything from how to pay the artists, to how Maura O’Malley: What we’re trying to build is an you engage the community, etc. It’s a shift in thinking affiliated network of practitioners. There’s an enormous about older adults, who we are, and what we’re capable of. need for training, on both the library side and the artist In terms of public libraries, services for older adults have side, on the community side and the individual side. Our been assigned to the outreach department. This work is efforts are to deliver programming that’s meaningful to the shifting that view from the needy, negative deficit view to local population. One of the ways we’ve been doing this is the positive, engaged, active view. So it’s been extremely working from the top down and the bottom up. So we’re fulfilling and we’ve learned so much from our partners. We bringing people together to meet these goals. What we hope learn every day about new ways to do this work, how to to see is, over time, that libraries across the nation are able to share the information. deliver this kind of programming. No one can do this work We actually measure the impact of the work on older on their own. The more we combine resources and work adults in terms of quality of life, particularly in terms of together, the greater the likelihood that more adults will be combating isolation. We’ll also be partnering with Self Help engaged—it’s a strategic rollout of the program itself, along Inc. They have created a computer system for isolated older with the dissemination and sharing of information. We need adults. They set up computers in homes of homebound to make a big effort to share the information and show what older adults, one that has a touch-screen system, so they happens. People need to see how it works and to see that can actually virtually join live programs in senior centers it’s beyond passive entertainment, and that we adults need and participate in the program. In partnership with Queens to identify as part of the group ourselves. There’s a better Public Library and Self Help, Inc., we’ll be piloting this way to grow older in this country, and that’s what we’d like technology in two libraries with creative aging programs. to see—meaningful arts programs all over the country in As many as five or six people can be virtually there in the which libraries and older individuals are creatively engaged room, and there is live interaction between the teaching in a vital community. ■

16 Preserving Your Memory spring 2013 Living with Alzheimer’s Disease Products That Make Life Easier, Simpler, and Safer

Every 69 seconds, someone in the United States is diagnosed with Alzheimer’s disease. There are now more than 5 million Americans living with the disease. What is not widely known—even by some physicians—is that there are products available that are made especially to help make Alzheimer’s patients’ lives better with the disease, and, in some cases, to help them remain living at home longer and safer.

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

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

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

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

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

For more information and many more helpful products, go to www.alzstore.com or call (800) 752-3238.

Alzstore Ad for color change.indd 1 2/6/13 2:42 PM Penny Marshall with her mom, Marjorie, on the set of Laverne & Shirley.

A Penny for Her Thoughts: An Interview with Penny Marshall

By Tamekia Reece Photos from Penny Marshall’s personal collection 18 Preserving Your Memory spring 2013 any know her as the spunky Laverne DeFazio of Preserving Your Memory: She Laverne & Shirley fame. Others know her as the hoped you would follow her dancing M award-winning director who worked magic on footsteps. Were you a good dancer? films such as A League of Their Own, The Preacher’s Wife, Awakenings, and Big, which was the first female-directed Penny Marshall: I was good at it, but I didn’t like movie to gross over $100 million at the U.S. box office. it. Especially as I got older, I was a little boy crazy. I wanted What many people don’t know about Penny Marshall to hang out with the boys, and I didn’t care about dancing is she, like many others, is the child of a parent who school. But we did every benefit there was, whether it was for developed Alzheimer’s. Her mother, Marjorie Marshall, arthritis, the March of Dimes, Army camps, veteran’s hospitals died of the disease in 1983. Penny’s memoir, My Mother … Wherever they would feed us, we went. We were three- Was Nuts, gives a humorous and brutally honest look at time winners on the Ted Mack’s Original Amateur Hour; we the relationship the two shared and how Penny went from were on The Jackie Gleason Show. We did everything. dancing in the basement to calling the shots on the big screen. We talked with Penny about her Preserving Your Memory: mom’s experience, her own health issues, How did you go from and how her mother’s memory will live dancing to acting and on—even after Alzheimer’s. directing?

Preserving Your Memory: Penny Marshall: I didn’t want Obviously, people will to be in show business, but I had sort of wonder about the title of been in it already. I didn’t call it show your memoir. Why did you business; to me, it was just my mother’s choose that title? weirdness. After I got divorced, I moved to California. My brother [producer Penny Marshall: Because Garry Marshall] lived there, and he my mother was nuts. Not because of helped me land a few small acting roles. Alzheimer’s, but before that. She said Then he asked if Cindy [Williams] and I some of the weirdest and harshest things. wanted to play the role of two “fast girls” She had a love for teaching dance. on Happy Days. Those roles led to the She wanted to be a dancer, but in the spinoff Laverne & Shirley. Later on, I had period when she grew up that wasn’t directed a few Laverne & Shirley episodes something you did. So she taught dance Penny Marshall’s new book, and was then asked to take over directing to everyone. She thought it was very My Mother Was Nuts. the movie Jumpin’ Jack Flash [starring important that everyone got the chance Whoopi Goldberg]. Then came Big … to see what it’s like to entertain. I did tap dance mostly, but she taught ballet, acrobatics, and Preserving Your Memory: Can you tell jazz. She always compared me to the 360 kids she taught in me a bit about your mom’s first signs the basement of our building. However, she wasn’t a stage of Alzheimer’s? mother. She was just pushy. Penny Marshall: It happened some time in the Preserving Your Memory: You early ’70s. I think it was when she performed on The Odd describe her as being obsessed with Couple. She wasn’t quite there, but we didn’t know what it her work as a dance teacher. was, you know? And the doctors didn’t know what it was. Later, when she did Happy Days and a couple of Laverne & Penny Marshall: She wasn’t only obsessive about Shirley episodes, she could still tap, but she couldn’t say a teaching dance; she was obsessive with dancing itself. line because she couldn’t remember. That’s all she liked to do. She tapped all around the house. She’d tap dance around the kitchen when she was eating or Preserving Your Memory: In your cooking, tapping on the linoleum. It’s what she lived for. memoir, you say, “her feistiness was We’d hear that tapping noise all day long. turning into forgetfulness.”

spring 2013 www.ALZinfo.org 19 Penny Marshall: Yes, because when we were kids, just letting them waste away in a corner. So it did affect she would call us different names, and that was before the my feelings toward the movie. I thought it was a great Alzheimer’s. She would make up names for all of us. That script, but part of my reason for doing it was because of my was just her. She would say, “Well, don’t you get tired of mother. being called the same name?” So with the onset of whatever it was, because they didn’t know what it was back then, we Preserving Your Memory: You and weren’t sure whether she got forgetful or it was just part of your siblings built a dance theater in her “thing.” her honor?

Preserving Your Memory: Tell me Penny Marshall: At Northwestern University about the official diagnosis. What where my brother and sister went to college. We built the was your reaction? Marjorie Ward Marshall Dance Center. She was still alive for the groundbreaking and my brother tried to explain we Penny Marshall: The doctors said, “It’s dementia,” were doing it because they didn’t have a dance facility at because that’s all they knew back then. It was like, “well the school. everyone gets that as they get older.” But it was shocking because she wasn’t even old. She was in her 60s or 70s. She Preserving Your Memory: The was still running around. relationship between you two was sometimes rocky. Now that you’re Preserving Your Memory: What were older and have a daughter of your some of the challenges your family own, what were some of your mom’s faced with the Alzheimer’s? strengths that you didn’t recognize when you were younger? Penny Marshall: They had to take her car keys away because she couldn’t remember where she lived. She’d Penny Marshall: She did what she was supposed take the bus and not know where to get off. One time to do in a very odd way. She chose to work as far as having the police picked her up and took her to the jail. She was a dancing school. I was a working mother, so I know it’s telling them stories of when she was younger and of her hard. And she made dinner like a restaurant. This one dancing school. It’s weird. She could remember everything would only eat this, that one would only eat that, my about music, the dancing school, and all that, but she brother was allergic to everything, my blind grandmother couldn’t remember present day. When her memory got didn’t know what she was eating. worse, we eventually had to have someone come in for 24-hour care. She would watch TV and laugh. We felt as Preserving Your Memory: It sounds long as she was still laughing, it was worthwhile. For the like she was a short order cook. last two years, it was terrible because she was in more like a vegetative state. She had been such an active and lively Penny Marshall: Yeah. And she dropped the woman, so that was the hardest part. turkey on the floor all the time. But she could make a good turkey. She made stuff that we still talk about today Preserving Your Memory: Your mom’s because we liked it. battle with Alzheimer’s had a lot to do with your decision to direct Preserving Your Memory: Many Awakenings, correct? people whose parents developed Alzheimer’s worry about their own Penny Marshall: Well, I read the script, and it read memory. It seems yours is very good. like a medical mystery to me. It was about four people For this book, you turned on a tape who were in a comatose state, and because of my mom’s recorder, talked about your memories Alzheimer’s, you wonder if they hear you. And I think and then had it transcribed? it’s important to treat them like human beings, instead of

20 Preserving Your Memory spring 2013 Marjorie and Penny Marshall, Easter, 1978.

Penny Marshall: Transcribed, and then fixed some Preserving Your Memory: Any advice of what was transcribed. But I am getting like my ma in you would give to others who have that I don’t know what I did yesterday. I know I was eating had a loved one diagnosed with the potato chips. Other than that, I can’t really remember. But disease? I do remember everything from back in the days. Penny Marshall: It’s a terrible disease, and I Preserving Your Memory: You were wouldn’t wish it on anyone. It’s a bummer, but you have treated for lung and brain cancer a few to try to do the best you can. Just try to keep going even years ago. How is your health now? though they’re not the same at times. Keep trying to do what they like, whatever it is. Try your best to help them Penny Marshall: I’m fine. I’m clean. I go when I’m keep smiling and laughing. ■ supposed to go for the PET, CAT, and MRI scans. I eat better.

spring 2013 www.ALZinfo.org 21 Fitness By Selby Bateman Take Care of Your Core Your abdominal, chest, and back muscles are the “core” of your body’s physical health.

or most caregivers, a typical day disease, being physically active is vital for can include plenty of physical maintaining health and independence as F activities—lifting, stretching, they age. carrying, walking, climbing steps, driv- “You’re never too old to increase your ing … you name it. To handle all that level of physical activity and exercise,” without injury or exhaustion, health says NIA Director Richard J. Hodes, experts recommend that caregivers M.D. “Go4Life is based on research pay special attention to their “core demonstrating real health benefits of strength.” The muscles associated with exercise and physical activity. It shows your abdominals, chest, and upper and how to exercise safely.” lower back make up the core that helps Most people tend to focus on one you carry out the many physical activi- activity or type of exercise—endurance, ties associated with caregiving. strength, balance, or flexibility—and There are many abdominal and back think they’re doing enough. Each type exercises that can help you strengthen is different, though. Doing them all your core. Plus, yoga and Pilates classes are will give you more benefits. Mixing it great ways to work on these core muscles. up also helps to reduce boredom and But core exercises don’t require expensive cut any risk of injury. Some activities Strength exercises build muscle. equipment or a gym. Many of them can fit into more than one category. For be done right in your own home. example, many endurance activities In fact, a new national exercise cam- also build strength. Strength exercises Exercise Instructions: paign from the National Institute on also help improve balance. The goal is Aging (NIA), called Go4Life, offers a to use all four types to help build your Targeted Muscles: Shoulders variety of simple and safe exercises that core strengths for everything you do. can improve the four basic categories of Here are four easy-to-do exercises, What You Need: Hand-held weights all exercise and physical activity—en- one for each type of activity. For more Stand with your feet shoulder- durance, strength, balance, and flex- examples, visit Go4Life at www.nia. width apart. ibility. Aimed at men and women 50 nih.gov/Go4Life. It is always a good years and older, Go4Life can be used idea to discuss any exercise program 1. Hold weights straight down at by caregivers of any age to improve with your healthcare provider first. your sides, with palms facing their core health. backward. The campaign grew out of concern that 2. Keeping them straight, breathe many older adults are not physically active. Strength Exercise out as you raise both arms in About 30 percent of Americans 45 to 64 Strength exercises build muscle, front of you to shoulder height. say they engage in regular physical activ- and even very small changes in 3. Hold the position for 1 second. ity, while only a quarter of those 65 to 74 muscle strength can make a real 4. Breathe in as you slowly lower do. And although people 85 and older difference in your ability to perform arms. can benefit from exercise, only 11 percent everyday activities like carrying 5. Repeat 10-15 times. report being active. For caregivers work- groceries, lifting a grandchild, or 6. Rest; then repeat 10-15 more ing with loved ones with Alzheimer’s getting up from a chair. times.

22 Preserving Your Memory spring 2013 Balance exercises can help prevent falls.

Flexibility exercises can help your body stay limber. Balance Exercise Balance exercises help prevent falls. Many lower-body strength exercises also will improve your Endurance Exercise Exercise Instructions: balance. You can’t balance without Endurance exercises are activities Targeted Muscles: Shoulders and good core strength, endurance, and that increase your breathing and upper arms control. Balance becomes especially heart rate for an extended period of important as you get older. time. Examples are walking, jogging, What You Need: Towel swimming, raking, sweeping, Exercise Instructions: dancing, and playing tennis. Build 1. Stand with feet shoulder-width up your endurance gradually, apart. What You Need: Sturdy chair starting with as little as 5 minutes 2. Hold one end of a towel in your You can do this exercise while of endurance activities at a time, right hand. waiting for the bus or standing in if you need to. Then try to build up 3. Raise and bend your right arm to line at the grocery. For an added to at least 30 minutes of moderate- drape the towel down your back. challenge, you can modify the intensity endurance activity on most Keep your right arm in this position exercise to improve your balance. or all days of the week. and continue holding on to the towel. 4. Reach behind your lower back 1. Stand on one foot behind a and grasp the towel with your sturdy chair, holding on for Flexibility Exercise left hand. balance. Flexibility exercises stretch your 5. To stretch your right shoulder, 2. Hold position for up to 10 muscles and can help your body pull the towel down with your seconds. stay limber. Being flexible gives left hand. Stop when you feel a 3. Repeat 10-15 times. you more freedom of movement for stretch or slight discomfort in 4. Repeat 10-15 times with other other exercises, as well as for your your right shoulder. leg. everyday activities. 6. Repeat at least 3-5 times. 5. Repeat 10-15 more times with 7. Reverse positions, and repeat at each leg. least 3-5 times. ■ spring 2013 www.ALZinfo.org 23 Food By Winnie Yu

Vitamin D and Your Brain

orgot where you placed your is emerging research that it is also Still, experts agree that more research keys? Can’t remember your new important for brain health.” is needed before declaring a direct link F neighbor’s name? Wondering between vitamin D and cognitive function. where you parked your car? If memory D for Discerning lapses have you fretting about your brain Exactly how vitamin D functions The Rx for Now health, you may need more vitamin D. to preserve cognitive function is un- In the meantime, it’s important to A growing body of research suggests clear, Brangman says. “It may increase get enough vitamin D in your diet. that the sunshine vitamin is involved in acetylcholine, a brain chemical and The amount you need varies by age cognitive function. Among the findings: neurotransmitter important for mem- and depends on whom you ask. “Sci- ory and other brain functions, that is entists and other public health organi- • A study published in 2012 in the found in low levels in many patients with zations are debating the amount that Journals of Gerontology looked at dementia,” she says. “Current drugs should be recommended based on vitamin D levels in 6,257 elderly for treating Alzheimer’s disease, the recent studies indicating the benefits of women and found that those with acetylcholinesterase inhibitors, work to vitamin D,” Dubost says. The National levels below 10 nanograms per increase the amount of acetylcholine Osteoporosis Foundation, for instance, milliliter (ng/mL) had more cogni- in the brain. Vitamin D may also help recommends 400 International Units tive dysfunction than women with nerve cells grow by increasing levels of (IU, equivalent to 0.01 mg) to 800 IU vitamin D levels of 30 ng/mL and nerve growth factor. The information (0.02 mg) of vitamin D daily for adults above. transmitted by the nerve cells in the under age 50, and 800 IU to 1000 IU brain is the foundation of everything (0.25 mg) for older adults. • Researchers at the University of our brains do, including memory, An important source of vitamin D Manchester measured vitamin D decision-making, judgment and is sunshine. The body makes vitamin levels in 3,133 middle-aged and complex thinking.” D when the skin is exposed to the older men in Europe and found Vitamin D is a fat-soluble vitamin sun. Dubost recommends sensible sun that those with higher levels did best known for its role in bone health exposure, which she describes as five to better on tests for attention and because it aids in the absorption of cal- ten minutes two or three days a week. speed of information processing. cium. Vitamin D also plays a critical This will vary depending on the season role in cell growth, immune function, and where you live (latitude). • A 2009 analysis using data from and the formation and development of Getting vitamin D from food isn’t the Third National Health and the brain. easy since few foods contain it naturally. Nutrition Survey (NHANES) “There is wide distribution of vitamin Some exceptions include oily fish— showed that vitamin D deficiency D receptors throughout the brain,” says salmon, tuna and mackerel—cod liver is associated with an increased risk Joy Dubost, PhD, RD, a spokesperson oil and egg yolks. (See recipe on the next for cognitive impairment. for the Academy of Nutrition and Di- page.) Fortified foods like low fat milk, etetics. “The presence of vitamin D non-dairy milk alternatives, and 100 “Overall, we are learning more and receptors in the brain implies it may percent orange juice are healthy options, more about the benefits of vitamin D,” have some effect on the function of the too. You can also get vitamin D from says Sharon Brangman, MD, a geri- brain. Some scientists have tentatively supplements (also called vitamin D3). atrician and professor of medicine at classified vitamin D as a neurosteroid. “Vitamin D supplements may be Upstate Medical University in Syracuse, Research has also shown that vitamin necessary for older people, those who N.Y. “It is the only vitamin that can D affects proteins in the brain that do not consume adequate amounts reduce the risk of falls when it’s replaced are involved in learning, memory and through their diet, people living in in people who are deficient, and there motor control.” northern latitudes, and for dark-

24 Preserving Your Memory spring 2013 In addition to sunshine, you can get vitamin D from salmon, tuna, mackerel, cod liver oil, egg yolks, low fat milk, non-dairy milk alternatives, 100 percent orange juice and supplements.

skinned people who need increased test your vitamin D level in your blood vitamin D you may need to receive exposure to the sun,” Dubost says. to ensure you have adequate amounts, through diet and supplements.” ■ “You may want to have your doctor which could then determine how much (For recipe, see page 26) spring 2013 www.ALZinfo.org 25 Healthy Recipe

Grilled Tuna With Warm Cherry Tomato Salsa

Here’s an easy tuna recipe that blends the freshness of Napa, the seafood of California, and the Tuscan way of spicing food. If you can’t find fresh tuna, use any firm fish, such as halibut or salmon.

Ingredients 4 small tuna steaks (about 4 to 6 ounces each, with bone) 1 tablespoon plus 2 teaspoons extra-virgin olive oil, divided 1 tablespoon lemon juice Vegetable oil cooking spray ½ teaspoon salt ¼ cup finely diced red onion (½ onion) 2 cloves garlic, minced 2 cups cherry or pear tomatoes, cut in halves 2 tablespoons chopped fresh flat-leaf parsley 1 tablespoon capers, optional Freshly ground black pepper, to taste

Directions 1. Rinse the fish and pat it dry with paper towels. Place it in a glass pie plate and drizzle with olive oil and lemon juice. Let the fish marinate in the refrigerator for at least 15 minutes and up to 4 hours. 2. Preheat grill. Place the tuna on a double-thick sheet of aluminum foil that has been sprayed with the cooking spray; place it on the grill. Grill the fish, turning it once, until it flakes and is not quite opaque in the center. This takes between 4 and 8 minutes per side, depending on the thickness of the fish. 3. Preheat oven to 400ºF. Combine the remaining 2 teaspoons of olive oil, the chopped onion, and the garlic in a glass, oven-safe pie plate. Bake for 7 to 8 minutes, stirring halfway through. Mix the salt into the tomatoes; stir the tomatoes into the onion mixture and continue to roast for 4 to 5 minutes, until the tomatoes are warmed and the onion is starting to brown. Remove from the oven, stir in the chopped parsley and capers, if using. Spoon the mixture evenly over the grilled tuna steaks. Add the desired amount of black pepper.

Source: Academy of Nutrition and Dietetics

26 Preserving Your Memory spring 2013 The First Rule By Mary Adam Thomas on Second Opinions: They’re Always Worth Considering in the Wake of a Serious Diagnosis

“Frontotemporal dementia is often misdiagnosed Parkinson’s disease, and Creutzfeldt-Jakob as a psychiatric problem or as Alzheimer’s disease, the disorder is often misdiagnosed.” disease.” —The Mayo Clinic —The National Institute of Neurological Disorders and Stroke “Lewy body dementia’s symptoms can closely resemble other more commonly known diseases The challenges that come with memory loss are difficult like Alzheimer’s and Parkinson’s.” enough. When a definitive diagnosis is hard to pin down, —The Lewy Body Dementia Association it complicates things even further. Unfortunately, there are several realities among the so-called “dementing disorders”: “Because the symptoms (of normal pressure there are many of them, their symptoms often mimic one hydrocephalus) are similar to those of other another, and doctors sometimes disagree when it comes to disorders such as Alzheimer’s disease, diagnosing them. However, treatment options and coping spring 2013 www.ALZinfo.org 27 strategies do vary by condition, so there is enormous value have frontotemporal dementia, which can lead to behavioral in an accurate diagnosis. changes and language problems. When those things For those reasons and more, patients and caregivers happen before memory issues are obvious, it can actually be dealing with dementia—in any form and identified by any misdiagnosed as a psychiatric issue.” label—should always consider pursuing a second opinion. Normal pressure hydrocephalus, or excessive fluid on the brain, is another condition that causes memory and balance The Right of Every Patient and problems that mimic those of Alzheimer’s disease, notes Dr. Caregiver Chagnon. The important difference between hydrocephalus It’s a good idea to seek a second opinion following any and Alzheimer’s, she points out, is that the former is treatable serious medical assessment, whether it’s a diagnosis or a when caught early enough. “By the time hydrocephalus gets recommended course of treatment. Patients and family obvious, it’s sometimes too late to do anything,” she says. “So members are becoming increasingly engaged in their we always encourage people with worrisome symptoms to get own healthcare, and seeking the input of more than one evaluated and get brain imaging if at all possible.” physician is more common than ever. Following such a Properly identifying these subtle distinctions among serious diagnosis as Alzheimer’s disease, it might even be conditions, she explains, can benefit patients and caregivers considered irresponsible not to pursue the expertise of at alike. Memory, balance and behavioral issues could also least one other doctor. be symptoms of a thyroid problem, a vitamin deficiency “People sometimes worry they’re going to offend their or a slow-growing tumor. “Those are things we can do doctors by bringing up the subject of second opinions,” says something about before they cause irreversible damage,” says Aimee Chagnon, MD, a neurologist who runs a private Dr. Chagnon. In these cases, second opinions that confirm practice in Sonoma, Calif. “I tell people that it’s not going initial diagnoses help clarify the proper way forward. to hurt my feelings or insult me. I don’t want anyone to have any kind of lingering doubt or question whether they Grappling with the Decision could have done something different—especially with a Given the emotionally wrenching nature of memory loss, devastating diagnosis.” families can feel overwhelmed just by the realities they If you are interested in seeking a confirming diagnosis face every day. Adding potential stress by seeking a second and your original physician objects to the idea, patient diagnostic opinion might seem like too much to bear. advocacy experts consider such resistance a red flag and an indication that the doctor is more concerned with personal “If a family is really struggling with an Alzheimer’s ego than patient outcomes. “It doesn’t matter if the doctor diagnosis or if they have reason to question it, I’ll remind likes you or is annoyed with you just because you want a them that they always have the option of getting a second opinion. Keep your eye on the ball,” urges Andrew second opinion,” explains Patricia Brooks, LCSW, PhD, Schorr, founder of the advocacy portal Patient Power and a psychotherapist who counsels individuals and families author of The Web-Savvy Patient. “This is about you or experiencing anxiety or depression related to illness, your loved one having the best possible health and quality chronic pain, and cognitive disorders. “But sometimes, of life. That’s what matters.” people question a diagnosis because they’re in denial, in which case we need to spend time educating them as a way Many Dementias Look the Same of helping them understand and accept the diagnosis.” In In her practice, Dr. Chagnon has seen plenty of patients those cases, she works with caregivers to facilitate realistic whose symptoms have been difficult to place into tidy expectations and help them prepare for and adapt to the diagnostic categories. Having issued initial, confirming changing abilities of the patient. and alternative diagnoses for numerous brain disorders, she As necessary, Dr. Brooks helps identify resources for her knows that the nuances of each case can affect how it is clients, assists them in pursuing additional medical opinions labeled, managed, and treated. and contributes her own expertise to help determine the “It’s not uncommon for people to be diagnosed with most effective next steps. “If I have a question about a client’s Alzheimer’s and end up having Lewy body dementia, which diagnosis, I ask whether a neurologist or other specialist was is a combination of symptoms that look like Parkinson’s consulted, I look at what kinds of tests were done, whether disease but involve quite a bit of hallucination and significant an MRI or CAT scan was done, etc. Then I may recommend behavioral changes,” she says. “The other thing we often that they seek a second opinion to take a more thorough look see is people being diagnosed with Alzheimer’s who actually at what’s going on,” she says.

28 Preserving Your Memory spring 2013 Coping with the Findings liabilities can help families understand what level of care When a second opinion confirms an initial diagnosis, will be required and what coping strategies we can begin to it can clear the way for patients and caregivers to put into place for caregivers.” begin focusing on managing the condition rather than questioning it. The Power of Information However, when a second opinion contradicts an initial Memory loss is all about unanswered questions. Second diagnosis, it’s important to figure out why. “If conflicting opinions can help patients and caregivers feel more in diagnoses come from two different neurologists, then I control by arming them with information. Bringing a fresh would ask the two physicians to discuss the case,” Dr. medical perspective to a case doesn’t always change its Chagnon says. “Many times, especially early on, symptoms outcome, but it often helps home in on a patient’s condition of these conditions can fluctuate from day to day. Patients in ways that can have a positive impact on care. ■ will have very good days and look great, and the very next day they’ll turn around and behave totally differently. When doctors actually communicate and report to one another “We don’t really have vastly different ways to what they saw and what family members describe as normal, treat the different forms of dementias; it’s then you can often get consensus on a diagnosis.” more that we can better anticipate some of Dr. Chagnon recommends that families also include the the symptoms and the problems, and what patient’s primary care doctor in any group discussions whenever the prognoses are going to be, when we possible. “Even though the primary isn’t spending a lot of time know exactly what we’re dealing with. If we with the patient, it can be helpful,” she says. “If we talk to each can help the people who will care for the other, we can usually come to the right conclusions.” patients and give them some ideas on how these problems can be mitigated, there’s Weighing the Value of Neuro-Psych great value in that.” —Aimee Chagnon, MD, Testing Neurologist When a definitive diagnosis is particularly difficult to come by, memory loss patients and caregivers have the “If a cognitive screening raises red flags that option of requesting neuropsychological evaluations. point to dementia, I refer to a neurologist Some patients and caregivers pursue neuropsychological to get more information about root causes. evaluations when their doctors have difficulty reaching Is it a brain tumor, dementia, delirium, a a definitive diagnosis. “Many patients fall into the UTI, is there history of alcoholism? All of cortical dysfunction categories, which have red flags that those things can cause changes in cognitive neurologists should be able to identify. But if that’s not function. It’s important to really explore that enough to clearly identify what’s going on, then thorough diagnosis of dementia to find out what’s neuro-psych testing might be worthwhile,” says Dr. actually going on. It’s essential that we get Chagnon. “It’s a long process and some patients find it to a clear diagnosis before formulating a tedious, but it can really be worth it because it allows us to treatment plan.” —Patricia Brooks, LCSW, see what parts of the brain are really affected.” PhD, Psychotherapist Neuropsychological testing, according to Dr. Chagnon, reveals where in the brain the problems reside, which helps “It’s important to seek a second opinion classify the pathology. For example, if early testing reveals following a diagnosis as serious as frontal brain dysfunction, that’s unusual for Alzheimer’s Alzheimer’s because research continues disease, which doesn’t affect the front portions of the brain to evolve. Does your doctor know all the until later in the disease’s progression. If, on the other hand, latest? Could there be something he or she testing reveals a mixed pattern of dysfunction, it might be hasn’t learned yet, or a clinical trial he or sign of vascular disease and should be treated accordingly. she doesn’t know about? If so, could that be Neuro-psych testing can also help shed light on near- something that could help you or your loved and long-term realities. “Sometimes, I’ll recommend a one? Why take the risk by not seeking a neuropsychological evaluation so that we can make a second opinion and finding out?” —Andrew determination about a treatment or care plan,” says Dr. Schorr, Patient Advocate Brooks. “Identifying the client’s strengths along with their spring 2013 www.ALZinfo.org 29 By Kevin Gault Hitting the Target: Researchers Take Aim to Find a Drug Therapy for Alzheimer’s Disease The latest clinical studies investigate different paths to a cure.

here is no drug that can cure Alzheimer’s disease, takes 10 to 15 years from the discovery of a way to create a but there are reasons for hope. A group of new drug until it reaches the marketplace, with an average T medications can ease the symptoms of Alzheimer’s total cost of $1.8 billion for research and development. and researchers are tirelessly exploring many paths in their Scientists are making large-scale efforts to find a drug quest for a cure. that cures Alzheimer’s. One example is the Alzheimer’s It’s important to understand how existing drugs work Disease Translational Research Program. Orchestrated as well as their limitations. “These drugs work for some by the NIH, this program has conducted more than people in slowing the progression of symptoms,” says Laurie 60 research projects and produced several compounds Ryan, Ph.D., Program Director for Alzheimer’s Disease that pharmaceutical companies have chosen for further Clinical Trials at the National Institute on Aging. “They development. can help for a period of time, but as the disease progresses, it overpowers the drugs and they lose their effectiveness.” A Variety of Approaches During mild to moderate stages of Alzheimer’s, FDA- Researchers at the University of Minnesota Center for approved medications called cholinesterase inhibitors (sold Drug Design have created a promising synthetic compound as Aricept, Exelon and Razadyne) slow progression of the that, in laboratory trials with mice, prevents the mental disease and sharpen learning and attention span. Scientists decline from Alzheimer’s. don’t have a complete understanding of how they work, “The goal of our research was to find a way to stop the but research shows that these drugs prevent the loss of body from producing beta-amyloid protein, which can a chemical in the brain that is essential for memory and accumulate in the brain and form hard plaque that causes reasoning. changes in the brain associated with Alzheimer’s,” says Namenda, a drug classified as an NMDA antagonist, Swati More, Ph.D., Research Associate at the Center for helps in the moderate to severe phases of Alzheimer’s. Drug Design. “We developed a drug candidate called This medication keeps the amount of the brain chemical psi-GSH that prevents the accumulation of this protein. glutamate at a steady level, which helps maintain normal Psi-GSH acts in a way that has never been tried before for brain function longer. the treatment of Alzheimer’s disease.” Temporary improvement from these drugs is beneficial Another new path that researchers are taking is using for people with Alzheimer’s, but researchers are constantly brain imaging to assess the effects of early treatment searching for a treatment that will permanently restore for Alzheimer’s. Many current drug trials include brain normal brain function and quality of life. imaging and testing of blood or spinal fluid. One reason for this is that scans of the brain—such as A Long, Complex Process magnetic resonance imaging (MRI) and positron emission Research for a drug that cures Alzheimer’s is a complex, tomography (PET)—can now detect plaque in the brain challenging process that relies on scientific discoveries of thanks to a substance called Amyvid. This liquid, which new ways to attack the disease. The process is expensive. is injected into the bloodstream, attaches to beta-amyloid According to the National Institutes of Health (NIH), it plaque in the brain, making the plaque visible in the scan.

30 Preserving Your Memory spring 2013 “Until now, we Many researchers believe a drug “cocktail” haven’t been able to that aims at several targets will eventually detect beta-amyloid be developed. plaque in the brain,” says Richard Mohs, Ph.D., Executive Director, Neuroscience Clinical Development, Eli Lilly and Company, “but with the diagnostic agent Amyvid, we can use a PET scan to estimate the amount of plaque in adult patients who are being evaluated for Alzheimer’s disease and other causes of cognitive decline.”

Targeted Three Drugs to be Tested Research Researchers are preparing to test three drugs to Many researchers determine their effectiveness in treating early-onset believe that a drug therapy that cures or manages Alzheimer’s disease, which is genetically determined Alzheimer’s will involve a “cocktail” of medications aimed and can affect people who are as young as in at several targets, an approach that is similar to current their 40s. The goal is to find a treatment that can treatments for many cancers, hypertension and diabetes. help prevent memory loss and thinking problems One of these possible targets is a protein called tau. With associated with Alzheimer’s from occurring in the Alzheimer’s, this protein in the brain becomes tangled first place. The drugs to be studied all combat the and reduces the ability of brain cells to function properly. toxic effects of beta-amyloid. They are: Finding drugs that prevent tau from twisting into tangles is • , an antibody that attaches to a goal of current research. Gantenerumab beta-amyloid and helps to remove it from the Inflammation is another research target. Studies have brain. revealed a lot about the body’s overall inflammatory , an antibody which binds to response and these insights might lead to anti- • Solanezumab beta-amyloid before it clumps together, inhibits inflammatory treatments that manage Alzheimer’s. the plaque formation process. Recent studies have shown that the way brain cells , a drug that blocks an enzyme, process insulin may be linked to Alzheimer’s disease. • LY2886721 beta-secretase, which is critical for beta- Scientists are assessing the role of insulin in the brain and amyloid formation, thereby reducing the amount these studies may produce medications that support cell of beta-amyloid produced in the first place. function and prevent Alzheimer’s. “Drug therapies hold great promise for the future, but The study will involve 160 volunteers who have it’s important to keep in mind that lifestyle factors can also one of several genes that cause early-onset have an impact,” says Dr. Ryan. “Exercise, good nutrition Alzheimer’s. “In most trials in Alzheimer’s disease, and staying mentally active lead to healthier brain aging, people are treating the disease after the damage which won’t prevent someone from getting Alzheimer’s is being done to the brain,” says study leader Dr. but will keep their quality of life at a higher level longer. Randall Bateman of Washington University. “And in We can’t change our genetic makeup, which is a factor in this trial we’re trying to treat the disease before that developing Alzheimer’s, but we can take control of our damage gets done.” lifestyle.” ■ spring 2013 www.ALZinfo.org 31 Long-Term Planning By Cari Jackson Edited by Bernard A. Krooks, J.D., CPA, LL.M The Will and Beyond Now is the best time to plan for the distribution of your wealth, and a will is one important tool for doing just that.

fter we pass, we leave behind our worldly effects—all of our A assets and belongings, as well as our debts. If you’re an older person, you should have a plan for how your fi- nances will be handled up until and af- ter your death, and crafting that plan re- quires far more than just writing a will. “You’re talking about the disposition of a lifetime of accumulated wealth,” says Dana B. Perry, Shareholder and Certified Elder Law Attorney with Chambliss, Bahner & Stophel, P.C., in Chattanooga, Tenn. “And the will is the last layer of designating how that wealth will be managed after your death,” says Perry, “while many people think it’s the first.” A will is an important tool for determining how your assets will be Where to Begin distributed. A will establishes in advance how you want your assets and belongings Trusts You Can Trust be put when funds become available, handled when you’re gone. It also Grodberg also takes stock of potential on how they can be used. In the case designates an executor who will over- complications. Are any of your heirs in- of a second marriage, you can place see the disbursement of your estate. capacitated? Are they spendthrifts? Are the money in a trust where your sur- However, the will only applies to prop- they minors or impulsive young adults? viving spouse can access it but cannot erty that does not already have a ben- In these cases, a lump sum inheritance change who inherits it when she dies. eficiary. Insurance policies, retirement could cause problems for heirs who are Be open to your attorney’s suggestions accounts, and joint accounts designate ill equipped to handle the responsibility. about how to structure your plan. a beneficiary or joint owner, which Likewise, second marriages can create overrules anything in the will. Before conflict after you’re gone. For instance, Of Sound Mind you walk into a law office, take an a surviving spouse may decide to rewrite When someone is diagnosed with inventory of your assets, both the types her will to exclude children and grand- dementia, amending an existing legal and their beneficiaries or joint owners. children from a previous marriage. In arrangement or setting up a new one Harold L. Grodberg, a Certified all of these cases, Perry says, “A trust can further complicate matters. And Elder Law Attorney, also encourages is an underutilized tool for preventing here, reasonable attorneys can dis- you to consider the second level of heirs, your heirs from using your hard-earned agree on a course of action. In such in case your children predecease you. “If money against your wishes.” cases, Perry seeks a letter from a ger- you die without heirs, the law says who’s A trust puts someone else in charge ontologist or neurological specialist going to get the assets,” says Grodberg. of your money and allows controls to that states that her client is of sound

32 Preserving Your Memory spring 2013 gregate your investments into one or just a few accounts if possible. Leave a letter of instruction with your heirs that de- tails your wishes for a funeral and points them to the will and other important documents. Keep your will in a fireproof box or cabinet—and make sure someone knows the combination. Or, better yet, have your attorney hold your will. Most attorneys do not charge for this service. In many states if you lose your will and die, you are deemed to have revoked it, but not so if your attorney was in pos- session of it. Where possible, communicate your wishes to your heirs with the aim of minimizing disagreements. If you are a child managing a parent’s estate, try If you are married and you have been diagnosed with Alzheimer’s to coordinate the discussion of your or dementia, you may want to focus your efforts on rewriting your parent’s finances with the whole fam- healthy spouse’s will. ily present, and as you enter the pro- cess, Perry says, “You need to be open mind. If someone with cognitive After a Diagnosis to your parents’ wishes and be prepared issues—or even just a person in their If you are married and you have been to let the process go where it will.” 80s—wants to write out members of diagnosed with Alzheimer’s or demen- their family, that presents a heightened tia, Grodberg focuses his efforts on re- The Right Lawyer level of scrutiny. The letter, in Perry’s writing the healthy spouse’s will. The Managing your estate in your twi- view, helps to make the will immune spouse who is suffering will most likely light years is vastly different from to challenge. However, “if there was a divest their assets and put them in the writing a will in your 40s or 50s. An case where a doctor was not willing to healthy person’s name. For the healthy elder law attorney has the specialized give a letter, it likely would prompt me spouse, the ailing spouse will no longer experience to anticipate your needs to consider whether the client should be the entire heir. Instead, Grodberg ad- and to minimize your estate’s and your be executing another will,” she says. vises establishing a trust that leaves one- heirs’ tax liabilities. Additionally, Grodberg disagrees. He believes such a third to the incapacitated spouse and laws differ state by state and year letter opens the will to challenge. He be- two-thirds to the next person. In some to year. You’ll need to reassess your lieves that incapacity is a legal issue, rather states, this arrangement could help the affairs at least every three to five years, than a medical one, and “until a person incapacitated spouse become eligible if not yearly. A trusted lawyer—and is adjudicated as an incapacitated per- for Medicaid assistance, and/or it can executor—can help you manage the son, they have capacity,” he says. Instead, ensure that the incapacitated spouse process so that all of your hard work Grodberg prefers to write a memo to the has the funds for medical needs. Keep continues to benefit the right people, file of his own evaluation of his client’s in mind, having Alzheimer’s, especially even after you’re gone. ■ competence, that he met with his client, early stages, does not mean you cannot they had a conversation that was coherent, do a will. A will requires the lowest form Bernard A. Krooks is managing and the next day the client remembered of capacity of any legal document. partner of the law firm Littman Krooks what was said. Either way, both attorneys LLP (www.littmankrooks.com). A certi- caution that major changes to your estate Communicate Your Wishes fied elder law attorney, he is a past at this point in your life can rankle your Work toward simplifying and stream- president of the National Academy of heirs, and you should consider whether lining your financial situation. Organize Elder Law Attorneys and past president your choices will leave a legacy of conflict. your forms and files in one place, and ag- of the Special Needs Alliance. spring 2013 www.ALZinfo.org 33 Brain-Boosting Puzzles Keeping Your Mind Sharp “Use it or loseBrain-Boosting it.” The message is simple. Puzzles If you don’t use your “Usemuscles, it or theylose willit.” no The longer message be as is effective simple. asIf you they don’t should use be. your Of muscles,course, the they brain will is no not longer a muscle; be as effectivehowever, as it hasthey recently should be.come Of course,to light thatthe “mentalbrain is notworkouts,” a muscle; such however, as solving it has crosswords recently come and toother light puzzles, that “mental can help workouts,” ward off such Alzheimer’s. as solving In thesecrosswords pages, and we otheroffer a puzzles, variety ofcan different help ward types off of Alzheimer’s. puzzles that In will these work pages, out your we offervarious a variety skills involvingof different memory, types of deduction, puzzles that and will letter work manipula out your- varioustion, and, skills we hope,involving also memory, provide youdeduction, with a tonand of letter fun! manipula- tion, and, we hope, also provide you with a ton of fun! 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Accountants’ 56 57 58 Music” (2 wds.) initials 56 57 58 Music” (2 wds.) initials spring 2013 www.ALZinfo.org 35 BRAIN-BOOSTING PUZZLES ™ Hidden-MessageHIDDEN-MESSAGE WORD-FIN Word-FindD Hidden-Message Word-Find After you have located and circled in the diagram all of the words in the Word List below, read the leftover (unused) letters from left to right, line by line, to reveal the end of a quip that begins “Real luxury is…” The words are found in the diagram After you have located and circled in the diagram all of the words in the Word List below, read the leftover (unused) letters reading forward, backward, up, down, and diagonally, and always in a straight line. from left to right, line by line, to reveal the end of a quip that begins “Real luxury is…” The words are found in the diagram reading forward, backward, up, down, and diagonally, and always in aYou straight are looking line. for a 51-letter phrase. BUTLER NANNY SRLORYou are Ilooking ENTALRUGS for a 51-letter phrase. BUTLER NANNY SEKYTREPORPTSRLOR I ENTALRUGS I EE CHAMPAGNE ORIENTAL RUGS DNOOVSEKYTREPORPT I NGU I ENMSH I EE CHAMPAGNE ORIENTAL RUGS DNOOV I NGU I ENMSH CHAUFFEUR PERSONAL TRAINER N I LHONAEHJOOWET CHAUFFEUR PERSONAL TRAINER OAUN I LHONAEHJOOWET I SCDSEEH I CSO DESIGNER CLOTHES PREP SCHOOLS MRNWVNETOAU I SCDSEEH I NMSHRL I CSO DESIGNER CLOTHES PREP SCHOOLS MRNWVNET I NMSHRL DIAMONDS PRIVATE JET ATTNAEAMOMHNAOC DIAMONDS PRIVATE JET ATTNAEAMOMHNAOCI LSRYV I I I OMAUHR FULL-TIME COOK PROPERTY DAGAI LSRYV I NTNLTYMFEE I I I OMAUHR FULL-TIME COOK PROPERTY CNLROAGBMALSFCNDAGA I NTNLTYMFEE GRANDEUR RACEHORSES CNLROAGBMALSFCN GRANDEUR RACEHORSES EOPTCPUSTATLEAG ITALIAN SHOES SWIMMING POOL HSAAOTTONEEOPTCPUSTATLEAG I I UR I ITALIAN SHOES SWIMMING POOL ORVOLFTHEMHSAAOTTONE I DRFS I UR I LIVE-IN MAID VACATION HOMES ORVOLFTHEM I DRFS LIVE-IN MAID VACATION HOMES SELEEMCHAMPAGNE SELEEMCHAMPAGNE MANSION PPREPSCHOOLSTYD MANSION SudokuPPREPSCHOOLSTYD To complete the puzzle below, fill in the squaresSudokuSUDOKU so that each digit 1 through 9 appears exactly once in each row,To complete in each column,the puzzle and below, in each fill enclosed in the squares nine-unit so block.that each digit 1 through 9 appears exactly once in each row, in each column, and in each enclosed nine-unit block. 6 951 56 7 951 46 315 7 946 131 8 9 9 1 6 8 7 9 8 6 1 7 4 8 3 1 76 4 57 3 6 76 9 57 138 6 29 138 2

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36 Preserving Your Memory spring 2013 BRAIN-BOOSTING PUZZLES PUZZLE ANSWERS ™ HIDDEN-MESSAGE WORD-FIND Match These Crossword 1 Crossword 2 Match These CrosswordRVS 1 I NCH PLAYCrossword WAI 2 L APB 1f, 2d, 3i,Match 4b, 5h, 6c, These 7j, 8l, 9a, 10k, Crossword 1 PLAYCrossword WAI L 2 APB Hidden-Message Word-Find 1f, 2d, 3i, 4b, 5h, 6c, 7j, 8l, 9a, 10k, RVS I NCH MERE AGR I L EO 11e, 12g. DEUCERVS I NCH CAPEPLAYMEREPLAY WAI WAIAGR L APB LI APBL EO 1f,1f, 2d, 3i, 4b,4b, 5h,5h, 6c, 6c, 7j, 7j, 8l, 8l, 9a, 9a, 10k, 10k, DEUCERVS CAPE I NCH SAMAR I TAN MTS Hidden-Message Word-Find 11e, 12g. I NERT I MANMEREMERESAMAR AGR AGR I I TAN L IEO MTSL EO DEUCE CAPE RES EASES After you have located and circled in the diagram all of the words in the Word List below, read the leftover (unused) letters 11e,11e, 12g. DEUCEI NERT CAPE I MANSAMAR I TAN MTS II NERT NS SUCCESS I MAN SAMARRES I TAN EASES MTS from left to right, line by line, to reveal the end of a quip that begins “Real luxury is…” The words are found in the diagram I NERT I MAN FORNOTHRES EASES I NG After you have located and circled in the diagram all of the words in the Word List below, read the leftover (unused) letters I NS SUCCESS FORNOTHRES I NGEASES reading forward, backward, up, down, and diagonally, and always in a straight line. I NSDAUB SUCCESS POL FORNOTHI PO I NG ASSERT from left to right, line by line, to reveal the end of a quip that begins “Real luxury is…” The words are found in the diagram Dropline DAUBI NS SUCCESS POL FORNOTHI PO ASSERT I NG Dropline DAUBSHELL POL PEPPYI POBESS ASSERT ARP ROMA You are looking for a 51-letter phrase. Dropline DAUB POL BESSI PO ARP ASSERT ROMA reading forward, backward, up, down, and diagonally, and always in a straight line. Dropline SHELL PEPPYBESSCA ARP I RNS ROMA DEW Regardless of which line you get SHELLOAF PEPPY SURE BESSCA I RNS ARP ROMA DEW You are looking for a 51-letter phrase. Regardless of which line you get SHELLOAF PEPPY SURE CA I RNSN I GHT DEW I RENE BUTLER NANNY SRLOR I ENTALRUGS into,Regardless the other of ones which move line faster. you get SOUNDOFOAF SURE REN CAN I RNS I GHT I RENE DEW into,Regardless the other of ones which move line faster. you get SOUNDOFOAF SURE REN TALKYN I GHT I RENE CSA into, the other ones move faster. SOUNDOF REN TALKYN I GHT CSA I RENE BUTLER NANNY WIND ARIES TALKY CSA SRLOR I ENTALRUGS into, the other ones move faster. WINDSOUNDOF ARIES REN EVE AF TERNOON SEKYTREPORPT I EE WIND ARIES EVEEVETALKY AF TERNOON AF TERNOON CSA WINDANTE METESARIES TEA DEAL GOBY CHAMPAGNE ORIENTAL RUGS ANTEANTE METES METES TEAEVETEA DEAL DEALAF TERNOON GOBY GOBY SEKYTREPORPT I EE TKOS YDS ERR HURL EP I C DNOOV I NGU I ENMSH Leapfrog ANTE METES ERRERRTEA HURL HURLDEAL EP I GOBYEP C I C CHAMPAGNE ORIENTAL RUGS LeapfrogLeapfrog TKOSTKOS YDS YDS DNOOV I NGU I ENMSH Leapfrog TKOSWord-Find YDS ERR HURLSudoku EP I C CHAUFFEUR PERSONAL TRAINER N I LHONAEHJOOWET 1. Wake Forest; 2. George Mason; Word-FindWord-Find SudokuSudoku 1.1. Wake Forest;Forest; 2. 2. George George Mason; Mason; SRLORI ENTALRUGS 3. Brigham Young; 4. Johns Hopkins; SRLORISRLORIWord-Find ENTALRUGS ENTALRUGS Sudoku 1.3. BrighamWake Forest; Young; 2. 4. GeorgeJohns Hopkins; Mason; SEKYTREPORPT I EE 678495123 CHAUFFEUR PERSONAL TRAINER N I LHONAEHJOOWET 3. Brigham Young; 4. Johns Hopkins; SEKYTREPORPTSEKYTREPORPT I EE I EE678495123678495123 OAU I SCDSEEH I CSO 5. Mount Holyoke; 6. Old Dominion; DNOOVSRLORI I NGUENTALRUGS I ENMSH 5.3.5. BrighamMount Holyoke;Holyoke; Young; 6. 4.6. Old JohnsOld Dominion; Dominion; Hopkins; DNOOVDNOOV I NGU I NGU I ENMSH I ENMSH 678495123529713468 NSEKYTREPORPT I LHONAEHJOOWET I EE529713468 DESIGNER CLOTHES PREP SCHOOLS 7. Virginia Tech; 8. Sarah Lawrence; N I LHONAEHJOOWET 529713468 OAU I SCDSEEH I CSO 7.5.7. VirginiaMount Holyoke; Tech;Tech; 8. 8. Sarah 6.Sarah Old Lawrence; Dominion;Lawrence; DNOOVN I LHONAEHJOOWET I NGU I ENMSH MRNWVNET I NMSHRL OAUOAU I SCDSEEH I SCDSEEH I CSO I CSO314628957529713468314628957 9.9. Bryn Mawr. OAUN I LHONAEHJOOWET I SCDSEEH I CSO 314628957 DESIGNER CLOTHES PREP SCHOOLS 9.7. VirginiaBryn Mawr. Tech; 8. Sarah Lawrence; MRNWVNETMRNWVNET I NMSHRL I NMSHRL MRNWVNETOAU I SCDSEEH I NMSHRL I CSO 132874695 MRNWVNET I NMSHRL ATTNAEAMOMHNAOCATTNAEAMOMHNAOC132874695314628957 ATTNAEAMOMHNAOC 9. Bryn Mawr. 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spring 2013 www.ALZinfo.org 37 (continued from page 9) “ When you’re caring for an Barnet suggests you also consider easy-to-remove layers. adult, it’s important to always Items like a shawl or a cape can provide warmth, when needed, but can also be removed easily if your loved one respect that individual’s gets overheated. “These kinds of garments are ideal because modesty and dignity.” there are no arm holes to deal with,” she points out. A type of clothing you may not have considered is a bath ­—Brittany Barnet cape. “When you’re caring for an adult, it’s important to always respect that individual’s modesty and dignity,” says Barnet. “A bath cape can provide these benefits to a person Dressing Dos and Don’ts who has to be bathed by a caregiver.” For a caregiver, dressing a loved one with dementia can When purchasing specialty items, such as a bath cape, it be a dreaded event. It’s often physically demanding. And, can be helpful to shop with a company that specializes in as with any interaction with a person with dementia, it can clothing for people with Alzheimer’s disease. be mentally exhausting. In the early stage of Alzheimer’s disease, your loved one Organizing and categorizing items—shirts with may be able to dress him or herself—with supervision. shirts, pants with pants, etc.­—is a helpful way to You can provide assistance, but allow as much assist your loved one. independence as you can during the dressing process. As the disease progress, however, you’ll need to get more involved. Regardless of stage, Barnet offers these tips for making dressing easier on both you and your loved one:

Dos • Do establish a routine by having dressing occur at the same time each day. • Do give clear instructions about what’s expected to happen. For example, “put on your sweater” is more helpful than “get dressed.” • Do lay your loved one’s clothing out in the order the clothes will be put on. • Do always respect your loved one’s modesty and dignity when you’re assisting with dressing. • Do compliment your loved one on how good he or she looks. Everyone wants to look and feel good.

Don’ts • Don’t take over if your loved one is able to dress him or herself, no matter how long it takes. • Don’t rush the process. Doing so will only create stress for both of you. • Don’t fuss over details like mismatched clothing.

With Alzheimer’s disease, dressing is usually the first daily challenge of many. Approaching this activity with the right attitude and techniques can help set the tone for the entire day. ■

38 Preserving Your Memory spring 2013

Zachary & Elizabeth M. Fisher Center for Alzheimer’s Research Foundation West 46th Street & 12th Avenue New York, NY 10036 (CARD 1 BACK) PERF FOLD PERF (CARD 2 FRONT)

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The Fisher Center for Alzheimer’s Research Foundation is one of the world’s largest The Fisher Center for Alzheimer’s Research Foundation is one of the world’s largest research teams leading the battle against Alzheimer’s disease—and you can help us! research teams leading the battle against Alzheimer’s disease—and you can help us! The tax-deductible donation you make today will help us continue to fund important The tax-deductible donation you make today will help us continue to fund important research to find a cure for Alzheimer’s. research to find a cure for Alzheimer’s.

By Mail: Place this card and your check in an envelope and mail your donation to the By Mail: Place this card and your check in an envelope and mail your donation to the FCF, One Intrepid Square 46th St. & 12th Ave., New York, NY 10036 FCF, One Intrepid Square 46th St. & 12th Ave., New York, NY 10036

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Fisher_BRC Fall 2012.indd 1 PERF FOLD PERF 10/24/12 9:46 AM