Memorypreserving your Spring 2008 The Magazine of Health and Hope

The Museum of Modern Art Offers Special Programs for Alzheimer’s Patients

Tony and Uncle Junior from HBO’s The Sopranos Is There a Link Between Alzheimer’s What Does HBO’s Disease and Uncle Junior Have to Parkinson’s Disease? Answers by Nobel Prize Winner Do With Memory? Dr. Paul Greengard

TV Chef Marvin Woods Shares Healthy Cooking Tips    

 







     



    


   




 

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Is There a Link Between Alzheimer’s Disease and Parkinson’s Disease? Together, the Fisher Center for Alzheimer’s Research and The Michael Stern Parkinson’s Research laboratories work to find new treatments. 8

The Power of a Song Dominic Chianese of HBO’s award-winning series The Sopranos discusses how music has made a difference in his life and the lives of others. 12

Can Art Help Unlock Memory? Alzheimer’s patients benefit from the Museum of Modern Art’s special programs.

16

Music Is a Tool in Alzheimer’s Care Research shows that music has power for people with Alzheimer’s. 20 spring 2008 www.ALZinfo.org 3 Contents 5 From the Editor’s Desk Welcome 6 News Briefs Read the latest news on Alzheimer’s disease and brain health. 8 Is There a Link Between West 46th Street & 12th Avenue, New York, NY 10036 Alzheimer’s Disease and 1-800-ALZ-INFO • www.ALZinfo.org Parkinson’s Disease? Michael Stern, Publisher Richard Shortway, Associate Publisher 10 Caregiver Voices Betsey Odell, Editor in Chief Dorothy Pierce shares excerpts from her journal. Alan White, Managing Editor 12 The Power of a Song William J. Netzer, PhD, Science Editor Jerry Louis, Graphic Designer 15 Preserving Your Memory Update Toby Bilanow, Bernard A. Krooks, Contributing Writers The movie we featured in our first issue has gone on to achieve numerous awards and nominations. 16 Can Art Help Unlock Memory? 20 Music Is a Tool in Alzheimer’s Preserving Your Memory is published by Care Vitality Communications 407 Norwalk St., Greensboro, NC 27407 (336) 547-8970 22 Food and Nutrition Chef and Emmy® Award-nominated television host Jennifer Sellers, Managing Editor Marvin Woods shows that comfort food can be healthy. Traci Shelton, Senior Art Director Kathy White, Account Manager Jan McLean, Creative Director 27 Fisher Center Research Lauren Croughan, Editorial Assistant Fisher scientists discover a possible way to prevent Traci Marsh, Production Director tau tangles in the Alzheimer’s brain. Contributing Writers: Susan L. Comer, Sam Gaines, 28 Ask the Experts Ginny Gaylor, Jason Schneider

Home-modification tips can ease the burden on the © Copyright 2008 by the Fisher Center for Alzheimer’s Research Foundation. caregiver and increase the independence, safety, and No part of this publication may be reproduced or transmitted in any form or by any means without written permission from the Fisher Center for Alzheimer’s dignity of the person with dementia. Research Foundation. Articles in this publication are written by professional journalists who strive to present reliable, up-to-date health information. 30 Graceful Exercise However, personal decisions regarding health, finance, exercise, and other The ancient practice of tai chi is a low-impact way to matters should be made only after consultation with the reader’s physician or professional adviser. All editorial rights reserved. Opinions expressed herein are stay healthy. not necessarily those of the Fisher Center for Alzheimer’s Research Foundation. This project was supported, in part, by a grant, number 90AZ2791, from the 32 Long-Term Planning Administration on Aging, Department of Health and Human Services. Grantees undertaking projects under government sponsorship are encouraged to express Elder-law expert Bernard A. Krooks gives advice on freely their findings and conclusions. Points of view or opinions do not, therefore, elder care costs. necessarily represent official Administration on Aging policy.

34 Keeping Your Mind Sharp Cover photo: Josh Wolff Give your brain a workout with these brainteasers. Made possible by a grant from 38 Medicinal Laughter Agnes the Wellness Woman offers her own unique brand of help. A leader in finding an Alzheimer’s cure

4 Preserving Your Memory spring 2008 From the Editor’s Desk Welcome s this issue of Preserving Your Memory goes to press, spring is almost here. This time of year, Mother Nature seems to have A music all her own, so what better time for us to bring you an issue highlighting the many benefits of music—especially the role it plays in preserving memory. In this issue we’ll explore music as a phenomenal therapeutic tool for Alzheimer’s patients and their caregivers. We’ll also learn how Emmy- nominated actor Dominic Chianese of The Sopranos shares his musical gifts with patients facing dementia. Music isn’t the only cultural avenue for those with memory loss. The Museum of Modern Art (MoMA) has launched a program that allows Alzheimer’s patients and their caregivers to experience museum art in a way that is sensitive to their needs. As you’ll read in “Can Art Help Unlock Memory?,” this MoMA program will be extending across the country. As always, we want to provide you with important scientific Betsey Odell information that will shed light on the work being done to help people preserve memory. At our core, the Fisher Center Foundation is about scientific research. We’re excited to share fascinating research on the link between Alzheimer’s and Parkinson’s diseases and how it may lead to a new understanding of dementia. I hope Preserving Your Memory magazine will show you ways you can enrich your life and the lives of those you love. Take the time to enjoy this beautiful season and add music to your life!

Warm Regards,

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

Betsey Odell Editor in Chief

For advertising information, please contact: Betsey Odell Kathy White Fisher Center Foundation Vitality Communications (212) 265-0223 (336) 547-8970, ext. 3327

About the Fisher Center for Alzheimer’s Research Foundation Since 1995, the Fisher Center Foundation, a 501(c)(3) nonprofit organization, has been providing hope and help to the public by funding research into the cause, care, and cure of Alzheimer’s disease and creating much needed educational programs. We are the world’s largest research team leading the battle against Alzheimer’s disease. Our team of internationally renowned scientists, under the direction of Nobel laureate Dr. Paul Greengard, has been at the forefront of research that has provided a conceptual framework for modern-day investigations into Alzheimer’s disease. Of every dollar we raise, 94 cents goes directly to research programs. For more information or to make a donation, go to www.ALZinfo.org. spring 2008 www.ALZinfo.org 5 News Briefs

The Latest News on Alzheimer’s Disease and Brain Health

Clinical Trials Updates For more information Several ongoing, noteworthy Al- on clinical trials, visit zheimer’s drug clinical trials have been www.clinicaltrials.gov updated:

• Prana Biotechnology Limited just concluded a Phase IIa trial for its drug, referred to as PBT2. Phase IIa measured the safety of multiple doses of the drug and whether it might slow the progress of Alzheimer’s disease. It also assessed whether the drug im- proved symptoms. The results of this preliminary study are expected to be available shortly. The drug is de- signed to prevent a toxic interaction between certain metals, such a zinc and copper, and beta-amyloid.

• Elan Pharmaceuticals and Transition Therapeutics are currently recruiting patients for Phase II trials for its drug, ELND005, which may prevent beta- amyloid from assuming a toxic form associated with Alzheimer’s. This study will test the multi-dose safety and efficacy (whether it improves mental function) of the drug in treat- ing mild to moderate Alzheimer’s. The study will be completed in about 16 months.

• Bapineuzumab, a humanized mono- clonal antibody that binds to and clears beta-amyloid peptide, is en- For more information on clinical tri- patients after the administration of a tering Phase III trials for Elan Phar- als, visit www.clinicaltrials.gov therapeutic protein molecule called maceuticals and Wyeth. The drug is etanercept. designed to provide the patient with Therapeutic Molecule Shows When given by spinal injection, antibodies to beta-amyloid directly. Fast Results in Patients etanercept (also known by its trade This large trial will determine wheth- name, Enbrel®) binds to a substance er the drug will effectively treat Al- A new study published in the Jour- called TNF and renders it inactive. zheimer’s disease. nal of Neuroinflammation documents TNF regulates inflammation in the marked improvement in Alzheimer’s brain and other tissues. Too much of it 6 Preserving Your Memory spring 2008 appears to be produced in Alzheimer’s The protein deposit, disease. By reducing the level of TNF called amyloid plaque, in the brain, scientists involved in the is considered a classic study have predicted an improvement marker for Alzheimer’s. in patients. Such rapid improvement, The drug known as a in fact, has been noted. However, only radioligand molecule about 15 patients were included in this binds to amyloid plaque, study. And certainly more will be re- which allows the plaque quired in order to know whether etan- to be measured using ercept (Enbrel) will be an effective Al- positron emission tomog- zheimer’s treatment. raphy (PET) scanning. Researchers were impressed by the This is the second stra- speed of etanercept’s therapeutic ef- tegic alliance with an ac- fect. Patients who received the spinal ademic institution Astra- injection showed marked improvement Zeneca has announced. in Alzheimer’s symptoms within min- “We look forward to utes of receiving treatment. Etanercept working with AstraZene- is FDA-approved for the treatment of ca on the development of several immune-mediated disorders, this promising research but was used off-label for this study. tool for the early detec- tion, tracking, and scien- AFFIRIS Begins Testing of a tific study of Alzheimer’s New Kind of Amyloid Vaccine disease in the living hu- man brain,” says Dr. Eric A newly developed Alzheimer’s vac- Reiman, executive di- Treatment possibilities for cine, referred to as AD01 has just be- rector of the Banner Al- Alzheimer’s are advancing. gun a Phase 1 clinical trial testing the zheimer’s Institute. safety and immunological characteris- tics of the vaccine, which is designed to Phase IIa Clinical Oprah’s O Magazine Lists “mimic” beta-amyloid but is chemically Results Show Promise Fisher Center As a Top different. The idea is to cause the body’s for EPIX Pharmaceuticals’ Alzheimer’s Charity immune system to make antibodies Alzheimer’s Drug that will clear beta-amyloid from the An article called “Give Smart” in the brain but avoid a T cell response that In December 2007, EPIX Pharma- December 2007 issue of the popular could result in brain inflammation (a ceuticals Inc. reported positive results O Magazine listed top charities to give complication of an earlier vaccine test- for its drug PRX-03140, which belongs to in various categories, such as can- ed by a different company). to the class of 5-HT4 agonists. cer, children’s health, and Alzheimer’s Results from the Phase IIa trial disease. The article, which utilized AstraZeneca and Banner showed that a once-daily dose of 150 rankings by Charity Navigator, listed Institute to Collaborate on New mg of the drug enabled patients to Fisher Center for Alzheimer’s Research Alzheimer’s Research achieve a modest 3.6-point improve- Foundation as the Alzheimer’s disease ment as measured by the Alzheimer’s non-profit most worthy of charitable In December, the Banner Alzheim- Disease Assessment Scale cognitive donations. Charity Navigator is an in- er’s Institute and pharmaceutical gi- (ADAS-cog) subscale. Patients receiv- dependent charity evaluator that evalu- ant AstraZeneca announced plans to ing a placebo showed a 0.9 percent de- ates the organizational efficiency of join resources in researching a newly cline on the same scale, according to more than 5,300 American charities. ■ developed molecule, which could help EPIX sources. identify how a key protein deposit The ADAS-cog endpoint is a current Check the Fisher Center website identified with the amyloid plaques in standard endpoint for evaluating cog- (www.ALZinfo.org) often for up-to-date Alzheimer’s grows and develops. nition drug efficacy. and expert-reviewed scientific news. spring 2008 www.ALZinfo.org 7 Is There a Link Between Alzheimer’s Disease and Parkinson’s Disease?

Dr. Paul Greengard, Director of the Fisher Center for Alzheimer’s Disease Research at The Rockefeller University

he Fisher Center for Alzheimer’s Disease Research synuclein.” These folding problems are believed to be major and The Michael Stern Parkinson’s Research contributors to the symptoms of each disease. Fisher and Tlaboratories are working together to find new Stern scientists are making progress in learning how to treatments and ultimately cures for Alzheimer’s disease harness the body’s own defenses against “badly” folded and Parkinson’s disease. They are the two most common proteins. This is one line of promising research aimed at neurodegenerative disorders, and because they share discovering new and effective treatments for these diseases. common connections, many researchers believe that understanding one will create insights into the other. 25 percent of people with That’s why the Fisher and Stern Centers have joined forces. These researchers have long sought clues that may link Alzheimer’s disease will also Alzheimer’s disease and Parkinson’s disease. Parkinson’s develop Parkinson’s disease. disease is characterized by a decline in motor function, such as the ability to walk, move, and speak, and mood and thinking disorders. Alzheimer’s disease and Parkinson’s Connecting the Proteins disease affect different regions of the brain, but, in both, One of the strongest links between Alzheimer’s and brain cells die and certain neurotransmitters (molecules Parkinson’s is that 25 percent of people with Alzheimer’s that signal nerve impulses between brain cells) are depleted. disease will also develop Parkinson’s disease, and Another link between Alzheimer’s and Parkinson’s involves many people with Parkinson’s will develop dementia. the way proteins fold. In both diseases, specific proteins Understanding why this occurs is expected to provide form the “wrong” fold or shape. In Alzheimer’s, one of important insights into both conditions. A clue came the proteins that has a wrong fold is “beta-amyloid.” several years ago when scientists were investigating how In Parkinson’s, the badly folded protein is “alpha- two proteins, beta-amyloid and alpha-synuclein were 8 Preserving Your Memory spring 2008 affecting the brain. In Alzheimer’s disease, beta-amyloid forms the plaques that accumulate in the brain. In Parkinson’s disease, the protein alpha-synuclein forms clumps, called Lewy bodies, within brain cells. Although Alzheimer’s plaques are composed mainly of beta-amyloid, they also contain a lot of alpha-synuclein. The Lewy bodies in Parkinson’s also contain a protein related to beta- amyloid. Several years ago, independent scientists developed mice having human genes that resulted in a rare form of Alzheimer’s, and other mice that had a human gene that resulted in a rare form of Parkinson’s. These mice showed symptoms of either disease depending on what genes they had. When scientists bred the two kinds of mice, the ones that contained both Alzheimer’s and Parkinson’s genes showed symptoms of both diseases. However, the presence of the Alzheimer’s genes caused a worsening of the Parkinson’s symptoms, and the presence of the Parkinson’s 3-D fMRI Map of Regions in the Brain that gene caused a worsening of the Alzheimer’s symptoms. Exhibit Blood Flow Changes in Response to Visual Stimulation Family Ties Scientists are using powerful MRI machines In a recent study, researchers showed that first-degree which allow, noninvasively, for the localization relatives of patients with Parkinson’s disease have an and visualization of active brain regions. increased risk of developing dementia or memory problems. Also, the younger the age at which Parkinson’s appears, the Image courtesy of Dr. Noam Harel, University of Minnesota greater the likelihood that family members will develop dementia. The findings appeared in the October 2007 issue risk of developing dementia or cognitive impairment. In of the Archives of Neurology, one of the journals from the other words, relatives of people who developed Parkinson’s American Medical Association. disease at an earlier age, have a greater risk of dementia In this study, researchers at the Mayo Clinic in compared to relatives of people who were older at the onset Rochester, Minn., looked at various groups of patients with of Parkinson’s. and without Parkinson’s, as well as their close relatives. The study included 1,019 first-degree relatives of 162 patients First-degree relatives of with Parkinson’s disease who were living near the Mayo Clinic. As controls, they included 858 relatives of 147 patients with Parkinson’s people in the same geographic area who were approximately disease have an increased the same age and sex makeup as people in the Parkinson’s disease group but who did not have the condition. In risk of developing dementia or addition, the researchers evaluated 2,716 relatives of 411 patients with Parkinson’s disease who were referred to the memory problems. Mayo Clinic from a wider geographic area. The study group surveyed the participants with a Although this study did not determine whether telephone questionnaire as well as cognitive tests and cognitively impaired or demented participants had a review of medical histories to assess the occurrence Alzheimer’s rather than some other condition, it is likely of memory problems. These would include conditions that at least some of the study participants had Alzheimer’s. like mild cognitive impairment, as well as more serious This study shows there may be genetic links between conditions like Alzheimer’s and other forms of dementia. Parkinson’s and dementia. It is possible that Parkinson’s They found that relatives of patients with Parkinson’s and certain forms of dementia share common genes that disease were at increased risk of cognitive impairment or predispose family members to one or both conditions. dementia. There may also be undiscovered environmental factors that Relatives of patients who experienced the onset of lie at the root of these diseases. Parkinson’s disease at age 66 or younger were at higher (continued on page 26) spring 2008 www.ALZinfo.org 9 Caregiver Voices

A Caregiver’s Journal While caring for her husband who had Alzheimer’s, Dorothy Pierce decided to keep a written record of her experiences. Here are her thoughts on caregiving along with an excerpt from her journal.

lzheimer’s dementia seems to van and could see Ed’s figure sitting tall sneak up on a person in the for probably his last ride. A disguise of “forgetfulness.” It A hoist was needed to transfer him from is irreversible; drugs do nothing but the van to a wheelchair and another to lift postpone the inevitable. Caregivers him into the bed. His clothes were removed suffer through watching the slow and a hospital gown and diapers were put regression, physical and mental. Some on. I wondered if I was being unrealistic Alzheimer’s patients live 20 years in having bought some new PJs and shirts … this forgetting state, and it’s very hard Visiting him at the new facility I found to witness these changes in a person him dressed and in a wheelchair in the whom we have known and loved. It has sunroom, and on another day he was in been called the “long good-bye.” the activities room listening to a woman As a caregiver/wife, I want to play old tunes on the piano. I pushed his suggest a way to witness and to cope. chair around the small courtyard and up After the initial months of denial, and down the halls. grief, impatience, anger, frustration, He was coughing a little. His neck was and prolonged sadness (not necessarily rigid and he seemed unable to turn his in that order), I started a journal as a head. His lower jaw was slack. I rubbed way of releasing my thoughts—and of Dorothy Pierce expresses her his chest and patted his shoulder. He slept feeling not so alone. And, of course, I again. The nurse and I agreed we needed feelings through art as well as sought caregivers who could help with to talk about how much treatment would my husband’s care. writing. She created this mixed- be given for some of his health conditions As I sat at the computer at the media painting to represent When I asked him, “How’re you doing?” end of a day, describing changes in her husband’s slow fade. he answered, “Very want,” which I think my husband, the pressure inside my meant “Very well.” Another time he replied, head seemed slowly to diminish, and no longer stand alone or walk. His limbs “Wonderful!” Toward the end of July he the heavy feelings of sorrow in my seemed to be freezing, becoming useless. asked someone else, “How are you?” midsection were channeled into words He smiled a little when he saw me, and The nurses liked him and agreed he that sometimes overflowed into tears. I wheeled him backward around the hall was a “sweet gentleman.” … Marital misunderstandings I had because his footrests had been removed I had gone to Dallas for the birth of hoped to resolve were tucked away and his rubber soles were braking forward our daughter’s twins and received a call forever. Hopes for communication motion. I gave him several kisses, told him that Ed was having trouble breathing through words surrendered to a kiss on how many people loved him, and rubbed and was unable to swallow. The nurse the cheek, a holding of hands. that spot between his eyebrows, a touch said there was gurgling in his throat and I think this time of resignation he used to enjoy. When I asked if he was oxygen had been prescribed. He was also happens when anyone we love is dying sleepy, he said, “yes,” so I knew he still being given morphine under his tongue to slowly before us. heard me. keep him comfortable. The doctor wanted I watched as he was hoisted into the to know if I wanted an antibiotic to be Final Journal Entries— van to carry him to the nursing home. I given. My mind whirled, and all the July - August 2001 tried to pat his hand and reassure him, weight of what I was about to say was on Arrangements were made to move Ed to but he seemed puzzled and extra tense my heart. I said “no” and that I would be a skilled nursing facility because he could and made no sound. I drove behind the back the next day. 10 Preserving Your Memory spring 2008 When I saw Ed he had a tube in his Dr. Ford had been to see him the The nurse called at 2:15 a.m. to say Ed nose and there was gurgling every time night before and said he probably had had died at 2:00 a.m. he took a breath. A spray, which was not pneumonia and his body was very tired When I arrived at the hospital in the an antibiotic, was added to the oxygen from fighting the infection. I remembered early morning, his bed was empty except periodically to help him breathe. The night seeing him one day in the lounge area for two boxes containing his clothes. ■ nurse gave him a few drops of morphine shivering after a shower and wondered if under his tongue. His eyelids flickered this had happened again while I was gone. Dorothy Pierce, Santa Rosa, California a little when she told him his wife was I thought of all the months and years of with him. I held his hand and told him sadness and inability to communicate. Join Dorothy, and share your caregiving how much people loved him, especially his I stayed by his bed until 1:45 a.m., holding story with other readers. Contact The children and sister. I knew at the same his hand, telling him about all the people who Fisher Center for Alzheimer’s Research time that my decision to withhold the loved him, saying the Lord’s Prayer several Foundation, West 46th Street & 12th antibiotic might end his life. Was that times, and telling him how sorry I was. Avenue, New York, NY 10036, or e-mail what he would have wanted? I would never see him again. them to [email protected]

Living with Alzheimer’s Disease Products That Make Life Easier, Simpler and Safer

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

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

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

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

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

With over 200 products that address various activities of daily living and caregiver challenges, the Alzheimer’s Store is dedicated to finding and providing products for people with Alzheimer’s disease and those caring for them. For more information and many more helpful products, go to www.alzstore.com or call (800) 752-3238. By Jennifer Sellers

The Power of a Song

Dominic Chianese, star of HBO’s award- winning series Photo: Josh Wolff Photo: The Sopranos, uses the healing power of music in his own life and in the “Core ‘ngrato …” lives of others. In a moving, mellow voice, a baritone sings a haunting Italian ballad of unrequited love. Everyone in the room sits ‘My First Love’ silently, drifting away into their own bittersweet memories. Bronx-born Chianese has been a singer even longer than The tragic beauty of the performance causes many to shed he’s been an actor. The 77-year-old has been performing a tear. music since his teenage years. “I eventually got into theater, This describes a popular scene from the season three but music has always been my first love,” he says. “I grew finale of The Sopranos—perhaps one of the most memorable up with role models like Bing Crosby and Frank Sinatra, scenes in the series’ entirety. “Core ‘ngrato,” translated and I loved listening to some of the opera greats of the into English as “The Ungrateful Heart,” was performed ’30s,” he says. As a second-generation Italian American, by the character of Corrado “Uncle Junior” Soprano, Chianese also learned many traditional Italian songs from played masterfully by actor Dominic Chianese. But this his father and grandfather—songs he still sings to this day. same scene could just as easily describe performances by When Chianese says he loves music, he doesn’t just mean Chianese at any number of senior centers and communities the music he grew up listening to; he means “all types of in the New York City area. music.” It might surprise many to know that Chianese, a Long before Chianese’s musical talent was broadcast native New Yorker, has a special appreciation for Country across America, he brought it to New York’s elderly citizens. music. In fact, he has even performed at the Grand Ole 12 Preserving Your Memory spring 2008 Opry in Nashville. “I’m probably the only person who has Chianese primarily visits senior facilities in the New York ever sung in Italian at the Grand Ole Opry,” jokes Chianese. City and Westchester County areas. While his singing has While he did perform in Italian, he also sung the classic always been popular among the senior citizens he visits, his Country standard “A Fool Such As I.” “I love Country Sopranos stardom has added an element of excitement to music,” says Chianese. “I guess his performances for many of you could just say that I love them. “To them, I was always music—all of it.” ‘just Dominic,’” he says. “Now, While music has always been I’m ‘Dominic from TV.’ an important part of his life, “But it has always just been Chianese is better known to me and an acoustic guitar,” the general public as an actor. he continues. “The songs I For decades, he has acted sing are the songs these people in theater, and on the big grew up with. You can see in and small screens. He even their eyes the happiness—and had a role in Francis Ford sadness—this music can bring. Coppola’s Oscar-winning The It brings memories.” Godfather: Part II. It was The Chianese says that music Sopranos, however, that made has the same effect on him, him a recognizable face. But bringing up memories of his even as his success in acting parents and grandparents. continued, Chianese never “Performing for senior citizens abandoned his first love. is important to me now,” he He continued to perform says. “I’m a senior citizen, too.” regularly with his band, the New York Sidewalkers, and Remembering recorded two albums: Hits “Stardust” and Ungrateful Heart. Throughout his years of Chianese’s real-life musical volunteering his musical talents were also incorporated talents, Chianese has noticed into his performance of that even people with dementia Uncle Junior on The Sopranos. seem to react to certain songs. “Chase really knows how He recounts a particular to pull out the talents of his performance where a woman cast and put them to use for with Alzheimer’s, who was the characters and the plots,” completely unresponsive before Chianese says of David Chase, and after his performance, was creator of the multiple award- AnthonyPhoto: Neste/HBO able to sing along when he got winning The Sopranos. On The Sopranos, Uncle Junior’s (Chianese) to “Stardust.” dementia redefined his relationship with Tony Chianese’s observation Mixing Music and Soprano (played by James Gandolfini). isn’t unusual. According to Memory Concetta M. Tomaino, DA, Chianese doesn’t just perform for the love of making MT-BC, director at The Institute for Music and Neurologic music. He believes in the power of music. He’s seen it in Function and vice president for music therapy at Beth his own life and he’s witnessed it in others, he says. As a Abraham Health Services in New York, in her research result, an important part of Chianese’s life has become presentation, The Role of Music in the Rehabilitation of his low-key performances at senior centers and retirement Persons with Neurologic Diseases: Gaining Access to “Lost homes in his area. Memory” and Preserved Function Through Music Therapy, “In 1981 I got back to my spiritual roots,” he says. “I “memories are not actually lost with dementia or with other wanted to adopt a lifestyle of doing for others and using brain injuries; rather, the ability to retrieve and gain access music to heal.” As an effect of this turnaround, Chianese to these is damaged. Music, then, can provide access not started visiting and entertaining senior citizens. He has only to specific moods and memories, but also to the entire continued this volunteer work for 25 years. thought-structure and personality of the past.” spring 2008 www.ALZinfo.org 13 In a clinical study conducted by Tomaino, persons with medium to late- stage Alzheimer’s were able to verbalize information from their past when listening to music of their personal preference. “One of the participants, Molly, who was non-verbal at the beginning of the music therapy intervention, began to speak after Photo: BarryPhoto: Wetcher/HBO hearing an Irish tune repeated for the third time,” says Tomaino in the study. “Although she only stated ‘That’s nice,’ it was the first coherent remark she had made. At that point the therapist asked Molly where she was from and she replied ‘from Ireland’ and then continued to talk about Chianese’s vocal performance made for her family and what a nice town it was. a memorable ending to season three of Even though the phrases were fragmented, The Sopranos. the images and ideas Molly was trying to present were clearly connected.” Fascinated by the connection between music and memory, Chianese himself began reading the latest studies on the topic. He educated himself on these matters not just as matter of personal curiosity, but to also improve his understanding of the people he performed for.

The Most Important Role Chianese’s exposure to people with Alzheimer’s disease and dementia may have helped him out in his other job­—his Emmy-nominated role on The Sopranos. His understanding of Alzheimer’s based on observations of those he had known with it helped inform his portrayal of a person with dementia. By the final season of The Sopranos, Chianese’s character, Uncle Junior, began showing significant signs of dementia. A diagnosis of Alzheimer’s disease was never mentioned as the cause of Uncle Junior’s dementia, but it was implied. “He was someone with a lot of shallowness and intolerance,” says Chianese of Uncle Junior. “But he also had a very vulnerable sense of himself. … I think it [his dementia] made him softer to viewers.” Unfortunately, Uncle Junior’s dementia, much like the rest of his life, was punctuated by violence and darkness. But off- screen, Chianese is bringing light to people through his music. Now that The Sopranos has concluded, Chianese hopes to Josh Wolff Photo: devote more time to his music—perhaps recording another album and more touring with his band. He also continues “You can see in their eyes the performing for New York’s senior citizens. “I believe a happiness—and sadness— community can only be as good as the individuals in it,” he says of his belief in volunteerism. this music can bring. It brings As for Chianese’s next big role: “The part I’m working on memories.” now is being Dominic,” he says. “I’m working on my music —Dominic Chianese and my personal growth.” ■ 14 Preserving Your Memory spring 2008 Update

Julie Christie Receives Multiple Awards for Her Role in the Critically Acclaimed Alzheimer’s-Themed Movie, Away From Her

preserving your n the premiere issue of Preserving Your Memory, we Memory highlighted the film Away From Her, starring Oscar® Summer 2007 I winner Julie Christie. At the time, the movie was just The Magazine of Health and Hope debuting. Since then, this touching love story has gone on to win praise from critics and moviegoers alike. The film has garnered numerous awards and nominations. Christie’s performance as a wife with Alzheimer’s was particularly Oscar ® Julie Christie winner stars with Research: Making Strides powerful, and it ultimately won her Critic’s Choice, Golden Gordon Pinsent in Globe, and Screen Actors Guild awards for Best Actress, Away Alzheimer’sToward Cure an and a nomination for Best Performance by an Actress in a From Her What America an Alzheimer’s love story Thinks: Leading Role at the 80th Academy Awards. of courage, compassion, The Alzheimer’s and finding the strength Away From Her’s sensitive and honest portrayal of to let go Survey Try These Alzheimer’s makes it a special movie to the staff of Brainteasers! Preserving Your Memory Keep Your and the Fisher Center for Memory Sharp Alzheimer’s Research Foundation. We would like to congratulate Ms. Christie, Sarah Polley (the film’s writer and director), and everyone else associated with the movie. The Preserving Your Memory_Spring07 1 1 praise and attention the movie has received is For a downloadable copy well deserved. ■ of this issue of Preserving 6/19/07 2:29:51 PM Your Memory, please visit www.ALZinfo.org/Julie.

spring 2008 www.ALZinfo.org 15 By Ginny Gaylor Can RT Help Unlock Memory?

Alzheimer’s patients benefit A from the Museum of Modern Art’s special programs.

Photo: Timothy Hursley

16 Preserving Your Memory spring 2008 By Ginny Gaylor e have all been moved by the power of a piece of them.” She adds that the program’s educators have noticed art, whether it is the careful rhythm of a poem, the change that comes over the Alzheimer’s patients after W the crescendo of a sonata or the bold brushstrokes sitting in the galleries for a period of time. “They have in a painting. The Museum of Modern Art (MoMA) in New been outside in Midtown Manhattan and they may feel all York City wanted to build on that power by creating an art kinds of symptoms that go along with Alzheimer’s such as program for people with Alzheimer’s. Now, museums across agitation,” she explains. “But a transformation takes place the country are creating similar programs. and they come alive in front of these works. That is the Launched in 2006, Meet Me at MoMA was the result of beauty of it.” several years of research to find art and create a program Rosenberg’s observations have been backed up by research that would give the most benefits to Alzheimer’s patients as well. A 1999 study from Brighton, England, looked at a and their caregivers. The free program is offered monthly 10-week art therapy program for Alzheimer’s patients. The on Tuesdays, when the museum is closed to the general researchers found that half of the participants showed a public. This allows decrease in depression. the small groups of The educators have noticed A Gracious Gift Alzheimer’s patients the change that comes over and their caregivers to the patients after sitting in Building on the feel like VIPs, as well the galleries. success of the Meet Me as assuring a more at MoMA program, quiet, individualized the museum recently approach. received a $450,000 grant from the MetLife Designed with Foundation to expand Alzheimer’s the project nationally. Patients in Mind The new program, The Francesca Rosenberg, MoMA Alzheimer’s director of the Project: Making Art community and access Accessible to People with program in MoMA’s Photo: Robin Holland Dementia, will broaden Education Department MoMA’s existing explains that the tours are based on a theme, providing a efforts across the country over the next two years. thread to connect all the works of art. “We try to make it Rosenberg stresses how important the visual arts and different each month, because we find we have many return programs like MoMA’s are to people with dementia, visitors and we want to keep it fresh for them,” she explains. saying both provide an entry for communication and the “We really thought about this population,” Rosenberg opportunity for engagement, “not only with art, but with says. “And what works of art we could use with them, what their caregivers, loved ones, and society at large.” She communication techniques, and how best to serve them.” continues, “This generous grant will enable us to share Trained educators lead the tour, engaging participants, what we’ve learned and help others across the country to creating discussions, and sharing bits of information. develop similar programming to enhance the lives of those Works by such modern masters as Henri Matisse, Pablo in their community.” Picasso, Jackson Pollock, and Andy Warhol have all been a part of the program. Check with Museums in Your Area Meet Me at MoMA allows Alzheimer’s patients to The Virginia Museum of Fine Arts in Richmond, the maintain their thoughts and creativity, with very Frist Center for the Visual Arts in Nashville, and the empowering outcomes. “If you came in and saw the Brooks Museum in Memphis are creating tours inspired program in action, you would have no idea it was a group by the MoMA program for Alzheimer’s patients and with Alzheimer’s,” she says. “They appear just like any other their caregivers. Many other museums across the country audience or group together looking at works of art.” To have also expressed interest in adopting this approach. date, more than 1,500 individuals living with Alzheimer’s In addition, similar Alzheimer’s-focused events have or other dementia have participated in the program. been cropping up at museums and galleries nationwide. The program is ideal for Alzheimer’s patients, says Contact museums in your area to find out if they offer (or Rosenberg. “They are right in front of them, the art is not plan to offer) a program for visitors with dementia. moving or changing, and they are given time to focus on spring 2008 www.ALZinfo.org 17 “Programs such as Meet Me at MoMA are important, Foundation, a Massachusetts-based organization that because they offer people with Alzheimer’s and their supports the care and treatment of Alzheimer’s patients and caregivers opportunities for mental and social stimulation their caregivers through non-pharmacologic methods. through art,” says Sibyl Jacobson, president, MetLife Dr. Zeisel says, “When people living with Alzheimer’s Foundation. “We are pleased to support MoMA’s disease discuss the works of art on this tour, their responses innovative program and help to expand it nationally.” are amazing. Their insights are profound and to the point, The first part of the expansion will include speaking their behavior shows much less agitation and anxiety, and engagements at a variety of upcoming conferences, they are transformed by the experience. The impact lasts including the American Association of Museums and the for days, if not weeks, and participants even remember the Society for Arts and Healthcare, to share details about the experience long after.” program. “We will be conducting seminars and providing While Rosenberg, and all those connected with the resources for the participants so they can go back to their Alzheimer’s programs, are working hard to assist other community and create a program of their own with their museums and local Alzheimer’s groups create their own resources,” explains Rosenberg. programs that best suit their own needs and collections, she In addition, a says the larger goal printed manual and is to change public webinars will be The Meet Me at MoMA Alzheimer’s perception of this created to help other program just celebrated its second disease. museums or galleries anniversary. MoMA provides who are interested many education in creating their programs for own program for specialized Alzheimer’s patients. audiences. Programs MoMA has already such as touch tours worked with the for the blind and Virginia Museum partially sighted, of Fine Arts to help sign-language the VMFA establish interpretation, its program. “We and captioned led a group of their programs recognize docents through Photo: Robin Holland the diversity of the their own galleries general public’s and talked about abilities and needs. techniques for making their collection accessible,” says Rosenberg says, “The Museum has long been committed Rosenberg. She hopes that as additional museums create their to serving audiences with disabilities and special needs. own programs, they will act as liaisons for other museums in We had a war veterans art center that dated back to 1945, their area. so even then we were thinking of audiences with special Rosenberg is particularly excited about the website, needs.” www.moma.org/alzheimersproject. “What is nice is this is Meet Me at MoMA may have just celebrated its second something that can also be used by individuals.” She cites anniversary, but according to Rosenberg the research examples of a daughter using artworks on the computer to continues. “As we do the program, we try new works of engage her mother, or staff at an assisted living facility using art,” she says. “Works that are narrative, such as Andrew reproductions to work with small groups. “We are trying to Wyeth’s Christina’s World, are tried and true. But others, make the print manual and the online resources so any of like a Mondrian, can spark conversation even though these people would find them valuable and useful,” she says. it is just colors.” She adds that the focus of the program continues to be concentrating on the Alzheimer’s patients’ Painting a Different Picture of Alzheimer’s abilities. Rosenberg worked with Dr. John Zeisel and Sean “We know that a diagnosis doesn’t mean a patient’s life Caulfield, founders of Artists for Alzheimer’s to develop the needs to stop being fulfilling,” Rosenberg says. “Looking at initial Meet Me at MoMA project. Artists for Alzheimer’s is a work of art can create great moments for them and their a project sponsored by the Hearthstone Alzheimer’s Family caregivers.” ■

18 Preserving Your Memory spring 2008 Caregivers: Get the most from doctor visits—patients deserve it.

Anyone who has provided care for someone with a debilitating disease such as Alzheimer’s can recognize the challenges of correctly interpreting and applying a doctor’s instructions. The American Medical Association (AMA) Foundation understands these challenges. That’s why it provides physicians with the resources to help caregivers, patients and physicians communicate effectively with one another to ensure that patients receive the best care possible. To help you get the most from doctor visits, follow these tips: • Write down questions. Prepare a list of questions • Report changes. Tell the doctor about any to ask the doctor before your visit. new or different symptoms your care • Bring your care recipient’s medicines. Bring all recipient is having. prescription and over-the-counter medicines • Ask questions. Before you leave the doctor’s your care recipient is taking. of ce, make sure you understand what the doctor has told you. Remember, the doctor is there to help. The AMA Foundation serves as the philanthropic arm of the AMA, developing programs to support medical education, public health and research. Visit www.amafoundation.org to learn more.

07-1091 AMAF HealthLitAd.indd 1 11/7/07 1:19:02 PM Music Is a Tool in Alzheimer’s Care Research shows that music has numerous benefits for those with Alzheimer’s.

Mozart concerto, Tchaikovsky’s “Nutcracker” suite, even a A round of “Row, Row, Row Your Boat,” may all provide benefits for a person with Alzheimer’s disease. A growing body of research suggests that music, like art and other creative forms of therapy, can stir emotions and memories, enhance enjoyment and self- esteem, and enrich the lives of people with dementia.

A Soothing Sound “Relaxation with the type of music that calms you down is very beneficial,” says Dr. Ardash Kumar, a music therapy researcher at the University of Miami School of Medicine in Florida. “To promote a sense of calm and well-being, you can listen to your favorite soothing music when you eat, before you sleep, and when you want to relax. Like meditation and yoga, it can help us maintain our hormonal and emotional balance, even during periods of stress or disease.” Encourage those with Dr. Kumar and fellow researchers Alzheimer’s to clap or sing found that music provided lasting along with music.

benefits to elderly men with Alzheimer’s InstitutePhoto: for Music and Neurologic Function disease. The men were provided with music therapy for 30 to 40 minutes a day, or communicate, people retained the ability to recognize five days a week, for a month. For weeks after joining in the musical tunes. One 84-year-old woman with severe musical program, the men showed less disruptive behavior, Alzheimer’s, for example, continued to sing old songs from slept better, and became generally more active and cooperative. her youth, and joined in whenever music was played to her. She twisted her face in disapproval when tunes were played Music and the Brain wrongly, sometimes exclaiming “Oh, dear!” One recent award-winning article called “Music, Memory The researchers reported that musical abilities seem to and Alzheimer’s Disease: Is Music Recognition Spared in be located in areas of the brain generally unaffected by Dementia, and How Can It Be Assessed?” recently published Alzheimer’s disease and concluded that people with dementia in the journal Medical Hypotheses, likewise points to benefits would likely enjoy more music in their environments. of music for people with dementia. Canadian psychologists gave tests of music appreciation to people with severe The Sound of Prevention dementia and found that even in the advanced stages of Music may be beneficial not just for those with Alzheimer’s disease, when many people are unable to speak Alzheimer’s, but for those who care for them as well. British 20 Preserving Your Memory spring 2008 researchers reported that playing an excerpt of Vivaldi’s example, during difficult times of the day, such as when the “Four Seasons” seemed to bolster attention in both healthy sun goes down or when moving from one room to another. older adults and those with Alzheimer’s disease. Music Humming a few bars of “Home on the Range” may be may even play a role in helping to ward off Alzheimer’s. comforting and reassuring to a person with Alzheimer’s Researchers from the Stritch School of Medicine at disease who may not even recognize the loved one standing Loyola University in Chicago found that retired orchestra in front of them. musicians who had spent a Other tips for music and lifetime of playing musical Researchers have noticed the person with Alzheimer’s instruments were less include: that musical abilities likely to develop dementia • Pick songs or music that in old age. The findings seem to be in the areas is familiar and enjoyable are consistent with others of the brain unaffected by for the person with suggesting that cognitive Alzheimer’s. Alzheimer’s disease. stimulation, be it doing • Tapes, CDs, radio crossword puzzles, learning a programs, even live music new language, maintaining may be beneficial. But stimulating social relations, avoid music that may be or playing a musical too loud or interrupted by instrument, can help to keep noisy commercials; too the mind sharp as we age. much stimulation can cause confusion and agitation. Music as Therapy • Turn off the TV, and close Nobody suggests that the door or curtains to music can reverse the ravages avoid over-stimulation. of Alzheimer’s disease, or • Choose music to set the take the place of a well- mood you’re hoping to structured program of care- create: Quiet music may giving or medical treatment. be suitable before bedtime, Rather, music therapy may while soft but upbeat tunes complement other forms of may be appropriate for a treatments. A familiar tune or special birthday celebration. old musical favorite may stir emotions and memories, prove • Encourage those with Alzheimer’s to clap or sing along or soothing, and encourage social connections among those play a musical instrument. stressed by illness. It’s no surprise that more and more nursing • Supplement music with fond reminiscences and family homes and hospitals include a music therapist on staff. photos. According to Concetta M. Tomaino, DA, MT-BC, The American Music Therapy Association, on the Web executive director at The Institute for Music and Neurologic at www.musictherapy.org, can provide a list of qualified Function and senior vice president for music therapy at Beth professionals in your area. But don’t be afraid to sing a song Abraham Health Services in New York, in her research or hum along on your own. presentation, “The Role of Music in the Rehabilitation of “Despite the increased acceptance and understanding Persons with Neurologic Diseases: Gaining Access to ‘Lost of the therapeutic benefits of music therapy in work with Memory’ and Preserved Function Through Music Therapy,” persons with neurologic impairments and challenges, music therapists working with patients with dementia have more research needs to done to demonstrate it’s efficacy in observed dramatic responses to music in patients for years. application with a wide range of diagnosis,” says Tomaino. “When familiar music is presented to these individuals, But, “as technology advances, especially in the area of attention is maintained, fragments of memories unfold, and neuro-imaging, and as clinical research continues, we will a true connection to the self takes place,” she says. be able to fully understand how music connects to essential While people with Alzheimer’s may lose the ability neurologic function.” ■ to speak or recognize loved ones as the disease takes its inexorable downward decline, many retain the ability to To find out more about Concetta Tomaino’s work in music remember songs from long-ago childhoods. Singing a therapy, or to see about participating in a music therapy round of “Rock-a-bye Baby” may help to ease agitation, for research study, visit www.imnf.org. spring 2008 www.ALZinfo.org 21 Food and Nutrition By Susan L. Comer

Healthy Comfort Foods with Chef and Emmy® Award-Nominated Television Plus, learn how a healthy diet can help preserve Host Marvin Woods memory.

hen you were a kid, Mom’s Low-Country Cooking, both of which tools that I would always utilize in life.” oven always held the prom- he authored. You may have even dined Talk about an understatement! Wise of something Woods’ parents, noting their warm and satisfying. Would it Marvin Woods, son’s growing passion, sub- be meatloaf, mac and cheese, author of scribed him to Betty Crocker’s or pot roast? She knew all Home Plate Cooking recipe cards. “By the time I was your favorite comfort foods. 13,” says Woods, “I was cook- Now that you’re the caregiver, ing meals on the weekends for you want to nurture her with the family.” And he was among those same cherished dishes— only a handful of guys taking only lighter. Experts maintain Home Economics at his New that a healthy diet may actu- Jersey high school. ally reduce the symptoms of But young Marvin’s real Alzheimer’s and help preserve “epiphany” came one morning memory. So, while comfort at age 14 in his Aunt Tiny’s foods can be soothing, the ex- North Carolina kitchen. “For tra fat and calories are anything breakfast it was pork chops, but. eggs, and grits—the first time Is there a recipe for trans- I ever had pork chops for forming tradition? Absolutely. breakfast—and she served it Just take a few fresh ingre- with sweet tea. And it just blew dients and healthy strategies my doors off!” says Woods. “I and add a pinch of creativ- never knew really how much ity. But don’t forget Mom’s effect that had on me until I secret ingredient. Says Chef became a professional.” Marvin Woods, “Whether you’re cooking professionally or at home, at one of the many restaurants from Southern Comfort Lite the number one ingredient with cooking New York to London where Woods While attending the Academy of Cu- is your heart.” has contributed his unique talents over linary Arts in Atlantic City in 1983, the past two decades. Or perhaps you Woods was tapped to help open Har- Pork Chops and Sweet Tea saw him preparing food on CBS This rah’s at Trump Plaza. He went on to Meet Chef Marvin Woods—that Morning, or read one of his recipes in build an impressive resume in such New is, if you haven’t already. Perhaps you O Magazine. York establishments as The Sea Grill at were among the 7 million regular view- Chef Woods’ love of food and cook- Rockefeller Center, Windows on the ers of Home Plate, the top-rated Turner ing came early. “My dad was the first World, and Helmsley Palace before South cooking show that, from 2002 person that took me in the kitchen heading abroad to fine-tune his skills. to 2006, featured Woods’ lighter take when I was seven,” says Woods, “and it It was during a mid-’90s stint at Café on traditional Southern cooking. Or was just to make some scrambled eggs. Beulah, New York’s “low-country” cui- maybe your cookbook collection con- My dad wanted me to be independent sine hot spot, that Woods started devel- tains Home Plate Cooking or The New so, in his mind, he was giving me some (continued on page 24) 22 Preserving Your Memory spring 2008 Healthy Recipes

Turkey Meatloaf Makes 6 servings Balance, variety, and moderation are the keys to a healthful diet. You don’t have to sacrifice good taste for good health. Modifying recipes by substituting low-fat foods for higher-fat ones is the best way to skim the fat. Here we turn traditional meatloaf into a more healthful entrée by switching from ground beef to ground turkey. Adding mushrooms to the mix adds flavor and texture without adding fat. Cremini mushrooms are simply baby Portobello mushrooms. They are dark brown and slightly firmer and more full-flavored than white button mushrooms. Look for mushrooms with no bruises, closed gills, and a rounded cap that ranges from one-half to two inches in diameter. If you cannot find cremini, plain white button mushrooms may be substituted.

Ingredients 2 tablespoons olive oil, Coarse salt and freshly ground 1 cup fresh white breadcrumbs plus more for pan black pepper 1/3 cup milk 1 large onion, finely chopped 2 garlic cloves, finely chopped 2 large eggs, lightly beaten 1 medium carrot, finely diced 2 teaspoons Worcestershire sauce 1 ¼ pounds ground turkey meat 12 ounces cremini mushrooms, ½ cup chopped fresh parsley (mix of dark and light) finely diced ¼ cup ketchup

Directions • Preheat the oven to 400 degrees F. Oil a 13 x 9 x 2-inch loaf pan. • Heat the oil in a large sauté pan over medium heat. Add the onion and cook, stirring, just until softened, about 2 minutes. Add the carrot and cook, stirring, until softened, about 3 minutes. Add the mushrooms, season with salt and pepper to taste, and cook, stirring occasionally, until the liquid mushrooms give off is evaporated, 10 to 12 minutes. Add the garlic and cook until fragrant, 45 to 60 seconds. Remove from the heat and add Worcestershire sauce, parsley, and ketchup. Transfer the vegetables to a large bowl to cool. • In a small bowl combine the breadcrumbs and milk, and let stand 5 minutes. Add the eggs and stir to combine. Add the breadcrumb mixture to the cooled vegetables. Add the turkey, season with salt and pepper, and mix well with your hands. Mixture will be very moist. • Form into a 9 x 5-inch oval loaf and place in the prepared pan. Transfer to the oven, and bake until an instant- read thermometer inserted into the center registers 170 degrees F, about 50 minutes. Remove to a rack to cool and tent loosely with foil. Let the meatloaf stand 5 minutes before serving.

spring 2008 www.ALZinfo.org 23 (continued from page 22) program is currently in place in Atlanta chemically enhanced “quick-fixes” like oping his signature style—blending his- Public Schools; Chef Woods’ goal is to smoked turkey neck. torically relevant influences such as those take it to every school in America. With • If a savory dish calls for sugar, use of northern Africa, South America, and “Droppin’ Knowledge,” Woods urges honey instead and sweeten to taste. the Caribbean, with traditional Southern middle and high school students to par- • Omit eggs and mayonnaise whenever dishes. The result is not only exciting to ticipate in family grocery shopping and to possible. In Woods’ crab cakes, for the palate, but is also health-conscious. choose a different herb or spice each week. instance, he uses a mixture of onions, “People eat my food and they go ‘Wow, “That alone will expand your repertoire bell peppers, celery, Dijon mustard, your collard greens are really light. They’re with food,” he says. Chef Woods has and lemon juice—no eggs, no mayo. flavorful, but I can eat these and not feel also developed a line of no-sodium spice • Incorporate grains. Substitute quinoa for like my blood pressure’s going to shoot blends and all-natural sauces, soon to be rice in side dishes. Toss couscous or cracked up,’” says Woods. “And why? Because I available in major grocery chains and on- wheat into salads. Add oatmeal to meatloaf. don’t use salt pork and fatback in them.” line at www.marvinwoods.net. • Instead of butter, cook with canola Instead, he braises them with caramel- More tips from Woods on lightening oil, which contains the best blend of ized white onions and carrots and veg- up comfort foods: fats for good health. etable stock, then adds fresh herbs such • Keep your dishes pure and simple with Just as Chef Woods fuses history with as rosemary, thyme, and sage, along with vegetable stock. Woods makes his own, innovation to create wholesome home- red pepper flakes, honey, and a touch of using stalks and husks of fresh corn, to- cooked food, you can tap into your own balsamic vinegar. “And I don’t cook ’em mato ends and tops, celery, and onions, family memories to recreate the goodness for eight hours,” says Woods. “I cook ’em including the peel (omit the root). “So of Mom’s table—with a fresh approach. for about 45 minutes to an hour.” you have this very floral liquid that After all, nobody gets nostalgic for extra The collard greens are part of the you cook with,” says Woods. Avoid fat and calories. ■ simple but cutting-edge menu at Woods on South, the highly anticipated res- Eating Your Veggies Like Your Mom Always Told You taurant Woods opened last October in May Help Stave Off Alzheimer’s Charlotte, North Carolina. Your brain’s favorite color might be orange, a new study suggests. Beta carotene, Another popular menu item is South- an antioxidant found in carrots, sweet potatoes, and cantaloupe, may help pro- ern-Exposed Fried Chicken. Rather than tect brain function over time. In the study, the results of which were published dredging chicken in lots of flour and in the November 12, 2007, issue of Archives of Internal Medicine, men who took egg, then dropping it in three-quarters of high doses of beta carotene for an average of 18 years scored higher on several an inch of lard—the traditional South- cognitive function and verbal memory tests than did those who took placebo. ern method of frying chicken—try the Francine Grodstein, ScD, of Brigham and Women’s Hospital and Harvard Medi- Woods’ way. Marinate the chicken for cal School, along with colleagues, utilized two groups: 4,052 men who in 1982 be- 24 hours in buttermilk seasoned with gan taking either beta carotene or placebo every other day and 1,904 short-termers paprika, garlic powder, salt, pepper, and who joined the study in 1998. Both groups were monitored through 2003 and, cayenne, to tenderize it. Then lightly while the newer group exhibited no cognitive benefit, members of the group who dust it with flour seasoned with the same took beta carotene for 18 years scored modestly higher on several tests. components used in the buttermilk (plus Long-term “oxidative stress” on cells may contribute to cognitive decline, lead- some onion powder and celery salt). ing to the eventual onset of Alzheimer’s. Antioxidants help combat the effects of Lightly fry the chicken in canola oil until oxidation, the same process that changes iron into rust. While some studies on each side is golden brown and finish it in beta carotene and cognition have been inconclusive, several population studies the oven for a delicious greaseless result. have suggested that a diet rich in such antioxidants as vitamin C, vitamin E, and beta carotene may help lower the risk of Alzheimer’s and preserve memory. Droppin’ Knowledge Beta carotene is also found in dark green vegetables such as spinach, broccoli, Marinades, herbs, and spices, says and lettuce. (The darker the green, the more beta carotene.) Woods, are the keys to healthy eating. As researchers continue exploring the effects of diet on Alzheimer’s, experts “Herbs and spices add flavor and not fat,” advise eating a variety of nutrient-rich fruits and vegetables as well as sources of he says. It’s one of the tenets of “Droppin’ heart-healthy fats like nuts and fish, which have also been shown to help protect Knowledge with Chef Marvin Woods,” the brain. And, as this and other studies indicate, the sooner, the better. a wellness program Woods designed to For a flavorful way to get more beta carotene in your diet, try Chef Marvin address spiraling health issues faced by Woods’ Spiced Carrots recipe on the next page. young people. Launched in 2006, the 24 Preserving Your Memory spring 2008 Healthy Recipes

Spiced Carrots Makes 6 servings This dish is crunchy, colorful, and delicious. Carrots will keep in the refrigerator in a plastic bag up to 10 days. Remove the green tops before storing, since they will shorten the carrots’ shelf life. Paprika is dried, ground, sweet red pepper. It is mildly flavored and prized in the kitchen for its brilliant red color. Make sure to keep paprika and other ground spices no longer than three to six months.

Ingredients ¼ teaspoon ground cumin Coarse salt and freshly ground 1 ½ tablespoons chopped, fresh ¼ teaspoon paprika black pepper flat-leaf parsley Pinch of cayenne (or to taste) 1 ½ pounds carrots, cut into 2 teaspoons olive oil julienne or matchsticks 1 tablespoon honey 1 teaspoon white wine vinegar

Directions • Using a small, nonstick sauté pan over low heat, combine the cumin, paprika, cayenne, and oil. Cook, stirring, until fragrant, about 2 minutes. Remove from the heat and cool slightly. Add the honey and season with the salt and pepper to taste. • Using a 4-quart saucepan, cook the carrots in boiling salted water until tender, 2 to 3 minutes. Transfer to a colander and drain thoroughly. • Place the warm carrots in a medium bowl. Add the spiced oil, vinegar, and parsley. Toss to coat and combine. Taste and adjust for seasoning with salt and pepper. Serve immediately.

*This recipe and the Turkey Meatloaf recipe on page 23 were reprinted with permission from Home Plate Cooking: Everyday Southern Cuisine with a Fresh Twist by Marvin Woods and Virginia Willis.

spring 2008 www.ALZinfo.org 25 (continued from page 9) devise treatments that keep vulnerable brain cells alive. That might stop the progression of either Alzheimer’s or Working Together for a Cure Parkinson’s and, depending on the stage of the disease Both The Fisher Center for Alzheimer’s Disease when treatment began, might allow the brain to heal. The Research and The Michael Stern Parkinson’s Research achievement of this goal depends on continued research. laboratories are actively seeking Fisher and Stern scientists an understanding of Alzheimer’s are using many technologies, disease and Parkinson’s disease, as including genetics, molecular well as any relationship between biology, and biochemistry to the two. The Director of both achieve this goal. laboratories, Dr. Paul Greengard, is the year 2000 recipient of the What the Research Nobel Prize in Physiology or Means for You Medicine. Dr. Greengard received Nobody is sure what causes this award for his fundamental Alzheimer’s or Parkinson’s, discoveries concerning how although advancing age, genetic information is transmitted within factors and a host of additional the brain, which he worked risk factors may play roles. Just out by providing a detailed because someone in your family understanding of the major brain has Parkinson’s disease or a signaling pathway that is affected form of dementia, doesn’t mean in Parkinson’s disease. Prior to you will develop either. Still, Dr. Greengard’s work, scientists it is important that researchers thought that the connections continue to delve into the root between brain cells, called causes of brain disorders like synapses, were static. The thinking Alzheimer’s and Parkinson’s. Only was that a signal coming from one Fluorescence Microscopy Image through basic research will medical brain cell and crossing the synapse That Shows Two Nanoparticles in scientists be able to uncover the would always have the same effect the Brain underlying mechanisms of disease on the brain cell the signal was This fluorescence microscopy and develop new and effective going to. Dr. Greengard showed image shows the distribution of two treatments. that this was not the case. He nanoparticles pumped gently into The Fisher Center for showed instead that synapses Alzheimer’s Research Foundation the brain. Visual studies like this help are regulated. Certain types continues to fund critical research of neurotransmitters actually determine what properties are best into the root causes of Alzheimer’s changed the way a given brain suited to deliver therapy to diseased disease. It and its sister cell reacts to a signal from another tissues. organization, The Michael Stern brain cell. Suddenly, the brain Image courtesy of Dr. Frank Szoka, Jr. and J. A. Parkinson’s Research Foundation, became much more complex. It MacKay, University of California at San Francisco support ambitious research was like discovering computer endeavors at medical centers software for the first time and realizing that computers across the country. To learn more, visit www.ALZinfo.org, needed software to work. Currently, Dr. Greengard’s The Alzheimer’s Information Site. ■ discovery is being translated into potential treatments for both Parkinson’s disease and Alzheimer’s disease, based on By www.ALZinfo.org, The Alzheimer’s Information Site. our modern understanding of signaling pathways in the Reviewed by William J. Netzer, PhD, Fisher Center brain. for Alzheimer’s Research Foundation at The Rockefeller Fisher and Stern scientists are working to map and University. Sources: Walter A. Rocca; James H. Bower; J. Eric understand signaling pathways in the brain and also Ahlskog; Alexis Elbaz; Brandon R. Grossardt; Shannon K. on other Alzheimer’s- and Parkinson’s-related projects. McDonnell; Daniel J. Schaid; Demetrius M. Maraganore; For example, they are attempting to discover how and “Risk of Cognitive Impairment or Dementia in Relatives of why brain cells live or die in each of the diseases. With Patients With Parkinson Disease,” Archives of Neurology, this understanding, the scientists hope to be able to October 2007; Volume 64(10): pages 1458-1464. 26 Preserving Your Memory spring 2008 Fisher Center Research Fisher Scientists Discover a Possible Way to Prevent Tau Tangles in the Alzheimer’s Brain ~Proceedings of the National Academy of Sciences

he two major hallmarks of fighting drug developed by scientists Alzheimer’s disease are plaques at Memorial Sloan-Kettering Cancer T made out of the protein called Center. The Fisher scientists reasoned “beta-amyloid” and tangles of the protein that this drug might also help Alzheimer’s called “tau.” Plaques accumulate outside because the drug was designed to block of cells throughout parts of the brain the chaperone, Hsp90. Remember, used for thinking, memory, language, Hsp90 is needed for p25, and p25 is and other aspects of behavior. Tangles needed to make tau into tangles. The accumulate inside cells in these same Fisher scientists reasoned that if they used brain regions. Both beta-amyloid and tau a very small amount of this drug, only proteins exist normally in the brain—not enough to block Hsp90 from keeping in the form of plaques or tangles but some but not all of the p25 properly rather as well-ordered parts of brain cells folded, they might be able to prevent tau or as in the case of beta-amyloid, bits of from tangling and do so without hurting protein that are secreted by brain cells. Fisher scientist Wenjie Luo the rest of the cell. To test this, they used The plaques and tangles are actually hopes to find a drug to fight a type of mouse that was bred to have sticky clumps of beta-amyloid or tau “folding” of tau proteins. badly folded tau protein. Dr. Luo fed that have taken on abnormal shapes. In the mice the Hsp90-blocking drug for other words, proteins have specific shapes chaperones stick to such proteins and several months. Then she examined the that allow them to function normally. either try to re-fold them into the brains of the mice and found that the Sometimes they take on abnormal forms proper shape or send them to the cell’s drug had prevented tau from tangling, as a consequence of physical stress. This recycling facility—to be chopped up while producing no ill effects. may be what is happening in the brains and in some cases re-used for parts. Even though most scientists think of people with Alzheimer’s disease. These Cells also contain proteins that have that tangled tau is an indirect result of mistakes in protein shape, or “folding,” a hard time keeping the right fold, even beta-amyloid accumulation, many still as scientists call it, prevent proteins from when there is no stress. Such unstable believe that the tangles do the brain functioning normally and may also cause proteins are still very useful to the cell. harm. By preventing their formation or direct damage to brain cells. That is what They just need pampering and certain by ridding the brain of these tangles, Fisher scientists think is happening inside kinds of chaperones do this job. One Fisher scientists hope to prevent some of the Alzheimer’s brain; beta-amyloid and of these unstable proteins is called p25. the memory loss and other devastating tau proteins have taken on the wrong fold It gets its pampering from a chaperone effects of Alzheimer’s. Right now, and are damaging the brain. called Hsp90 (that stands for “heat Fisher scientists are planning to test Bad folding is not restricted to the shock protein weighing 90,000 Daltons). whether the mice that have been proteins believed to cause Alzheimer’s Without Hsp90, p25 would be quickly treated with the tangle-reducing drug disease; it can happen to just about chopped up by the cell and discarded. are smarter and have better memory any protein. Fortunately, our body’s Although p25 is needed by the cell, it can than the mice with tangles that have cells, including our brain cells, can also cause trouble. In fact, it is one of the not been treated. If the drug helps the defend themselves against badly folded proteins that cause tau to form tangles. tangled mice, it would be a candidate proteins most of the time. The cell’s Drs. Wenjie Luo and Paul Greengard for clinical trials in humans, and not defender is another type of protein at the Fisher Center for Alzheimer’s just to treat Alzheimer’s disease but called a “chaperone,” which recognizes Research may have found a way to correct other neurological diseases that are proteins that are badly folded. In fact, this. They experimented with a cancer- caused by badly folded tau. ■ spring 2008 www.ALZinfo.org 27 Ask the Experts Do you have a question you would like to ask the experts at the Fisher Center for Alzheimer’s Research Foundation? If so, please call 1-800-ALZINFO, visit ALZinfo.org, send surface mail to Fisher Center for Alzheimer’s Research Foundation, West 46th Street & 12th Avenue, New York, NY 10036, or e-mail [email protected]. Home-Modification Tips

Many readers have written to • Helpful safety products can be our experts asking about home found here: www.alzstore.com adaptations that can ease the burden on the caregiver and Fire Safety increase the independence, • Install smoke detectors and check safety, and dignity of the per- and replace batteries regularly. son with dementia. • Keep fire extinguishers accessible If you decide to have your Alzheimer’s- in every room. afflicted loved one live at home in a fa- • Eliminate poor wiring and over- miliar environment, it is important to loaded sockets. consider certain safety modifications, • Install radiator covers and insulate such as the ones below. hot water pipes to prevent burns. Since each person with Alzheim- • Remove dials on stoves and ovens er’s is different, both in the stage of to prevent your loved one from the disease and its manifestations, Keep fire extinguishers mistakenly turning them on. not all of the modifications sug- accessible in every room. Also remove space heaters and hot gested will apply in your situation. plates. Use this list as a guide and adapt • Prevent fires by moving furniture the suggestions accordingly. The home- appliances, cutlery and other sharp so that it is not in contact with ra- owner can do some changes, whereas kitchen objects, hand and power diators. others may need to be done by a handy- tools, firearms, and razor blades to • Lower the hot water temperature man or contractor, which may involve a prevent accidents. to 120 degrees to prevent scalding. significant investment. Visit us at www. • Use an electric razor while shav- • If your loved one smokes, restrict ALZinfo.org for more information. ing. it to a non-carpeted area with a • Store medications, household non-upholstered chair to minimize General Safety cleansers, and insecticides in a risk. locked cabinet to prevent acciden- • Provide large, deep ashtrays to pre- • Post emergency numbers for doc- tal ingestion. vent falling embers. tor, police, fire, ambulance, and • Install outlet covers to prevent readily available family members electrocution. Preventing Falls/Improving near a centrally located telephone. • Use sturdy chairs that do not tip. Mobility • Disable automatic locks on storm • Remove or pad furniture with and screen doors as to not get sharp corners. • Build a ramp to the front and back locked out, and hide an extra key • Remove fake fruit and other “look- doors of your house. in case it happens. alike” decorations such as refrig- • Install a stair/elevator chair to help • Put decals on glass doors to pre- erator magnets to prevent choking your loved one get up and down vent your loved one from walking or injury to teeth. stairs. into them. • Use sturdy plastic plates to prevent • Install handrails in hallways and • Lock up objects that might present breakage. stairways, put a gate on the stair- a danger, such as matches, kitchen • Hide car keys if necessary. way and grab bars in the bath- 28 Preserving Your Memory spring 2008 room. Make sure all lighting one has accidentally discarded in these areas is maintained. something of value. • Install locks on the doors to • Have consistent background the cellar/basement and attic. noise such as music they chose or • Add non-skid strips and re- nature sounds. pair or remove carpeting on steps. Managing Wandering • Tape or paint stair edges to increase their visibility. • Fence in your yard to reduce • Remove clutter that may the chance of your loved one wan- contribute to slips and falls, dering too far. Install a lock. This including area rugs. applies to swimming pools, too. • Use assistive devices as neces- • Install additional locks, a mo- sary, whether a cane, walker, tion detector, or an alarm or or wheelchair, which can help buzzer on exit doors to prevent your loved one maintain his/ your loved one from trying to her independence by remain- leave without you knowing. ing mobile. • Install safety locks on win- • Remove low furniture like Use a shower chair dows, and safety bars on ones coffee tables that might be a or tub seat for bathing. above the first floor. tripping hazard. Use a handheld shower wand. • Provide your loved one with • Keep a clear path in the cen- an identification bracelet, and a ter of rooms so that your card in their wallet along with a loved one can walk around safely. • Keep furniture arrangements con- note in case of wandering. • Post pictures or signs as cues to sistent in all rooms because people help your loved one find his or her who are disoriented may use these way and use objects appropriately. objects to remember. Do this also • Avoid placing electrical cords with personal belongings. If not, across walkways, or tape them anxiety may occur. down. Make sure lighting in these • Use a shower chair or tub seat for areas is maintained. bathing. Use a handheld shower • Use non-skid mats in bathrooms, wand. bathtubs, and showers. • Simplify clothing to enable easy • Use nightlights in hallways and dressing. bathrooms. • Use grooming tools specifically de- signed for people with motor skill Improving Daily Activities deficiencies (e.g., curved hairbrush • Enroll individuals with Alzheim- handles and toothbrushes) er’s or dementia into the Safe Re- • If more than one person is a care- • Add an additional bathroom or turn program available through giver, post a list of specific respon- have a portable toilet available to your local Alzheimer’s Association sibilities that each one should aid a person with incontinence. chapter. perform to prevent misunderstand- • Put plastic covering on furniture to • Have several photos of your loved ings and forgetfulness. (Use: www. protect it. one available should they get lost. lotsahelpinghands.com for an on- • Prepare food that is easily eaten • Notify the police who patrol the line caregiving tool.) with fingers and provide straws for neighborhood that your loved one • Post a calendar on an obvious wall drinks. has dementia and may wander. and mark each day. Also record • Use a vinyl tablecloth that can be Provide a photo. appointments and list activities to easily cleaned. • Notify neighbors of your loved one’s help them regain a sense of time • Store valuable items in a locked or condition, and caregivers’ schedules; passing. Also place clocks promi- inaccessible area. ask them to call you if they see your nently for this effect. • Check the trash in case your loved loved one unattended. ■ spring 2008 www.ALZinfo.org 29 Fitness By Jason Schneider

Graceful Exercise The ancient practice of tai chi is a low-impact way to stay healthy.

xercise is important for people flow freely, and integrate many of them.” a good range of motion at the joints, of all ages, but can be especially As a low-impact and aerobic exercise, Comana adds. “Coupled with the slow Ebeneficial to people with memo- tai chi can help improve physical condi- movements, [tai chi] helps with many ry problems, as well as their caregivers. tion, muscle strength, coordination, and age-related conditions such as arthritis,” Low-impact exercises, such as wa- flexibility; ease pain and stiffness; and he says. ter aerobics, yoga—and even simply improve sleep. walking—are often suggested for older “[The various forms of tai chi] em- Staying Active adults. To improve balance and coordi- phasize movement through three planes Because inactivity can lead to muscle nation, as well as combat joint stiffness (breathing, relaxation, and meditation), weakness and other problems, it’s im- and increase calmness and awareness, and thus help maintain functional mo- portant for people with Alzheimer’s to tai chi is an ideal choice. bility at joints and integrate multiple joint continue physical activity as long as pos- movements, which helps older adults sible, says The Cleveland Clinic. An Ancient Practice maintain their functional capacity,” says And although exercise doesn’t stop Tai chi, a mind-body practice that Comana. “In many of the movements, the disease from progressing, it gives pa- originated in China around the 12th the eyes are closed, challenging the bal- tients a feeling of accomplishment. century A.D. as a martial art, focuses ance centers of the body. This certainly is “In general, exercise improves cerebral on moving the body blood flow, bringing slowly and gently more oxygen to the Persons with while breathing brain to help main- deeply and medi- dementia tain neural and cog- tating. Studies have benefit from nitive function,” says suggested that tai these basic, Comana. “Tai chi chi can help boost simple movements might be older adults’ immu- movements. difficult to recall or nity to viruses and perform with these improve their bal- [dementia] patients; ance, thereby help- basic, simple move- ing to prevent falls. ments would have to “The premise is be employed.” to coordinate the The Mayo Clinic movements with reports that up to breathing, and 70 percent of people many of them are with Alzheimer’s simple movements also have symptoms or can be modified of depression. They to fit the needs of may eventually with- older adults,” says draw from all ac- Fabio Comana, MA, MS, ACE-CPT & key to functional capacity, given the risk tivities because, over time, they lose the LWMC, ACSM HFI, CSCS, CISSN, of falls with older adults. It’s great train- ability to take part in the activities they exercise physiologist and research scien- ing for balance and coordinated move- once enjoyed. Exercise, such as tai chi, tist with the American Council on Ex- ments, parameters lost as we age.” might help reduce depression in patients ercise in San Diego, Calif. “It teaches the Movements in tai chi use the person’s able to do the exercise and may alleviate participant to evolve the movements, to own body as resistance and maintains boredom or loneliness. 30 Preserving Your Memory spring 2008 Precautions As with any exercise, there are some precautions to take into consideration before practicing tai chi. Although rela- tively safe, like any exercise, it should be done with care. The National Center for Complementary and Alternative Medi- cine, part of the National Institutes of Health, offers these tips: • Tell your healthcare provider if you are considering learning tai chi for health purposes, especially if you have a health condition for which you are being treated, if you have not exercised in a while, or if you are an older person. • If you do not position your body properly in tai chi or if you overdo practice, you may get sore muscles or sprains. • Tai chi instructors often recom- mend that people not practice tai chi right after they eat, when they are very tired, or when they have an active infection. • Use caution if you have any of the conditions listed below, as your Tai chi originated in health care provider should advise China around the you whether to modify or avoid cer- 12th century A.D. tain postures in tai chi: - Pregnancy - Hernia - Joint problems, back pain, sprains, a fracture, or severe osteoporosis helping to control many of the health No matter what form of exercise you • A complementary/alternative medi- problems found in older adults, such as choose to do, you can help improve your cine approach should not be used to diabetes, high blood pressure, and high loved one’s quality of live—as well as replace conventional medical care cholesterol. your own. ■ or to delay seeking that care.

Getting Started Online Resources As the caregiver of a person with Al- Listed below are a few resources for finding additional information zheimer’s, you may want to explore your about exercise and Alzheimer’s disease. community’s resources to find exercise • American Council on Exercise www.acefitness.org programs or classes. You may even want to start a class yourself for other care- • The Cleveland Clinic www.clevelandclinic.org givers and Alzheimer’s patients. There • The Mayo Clinic www.mayoclinic.com are many resources available online (see • MedlinePlus www.medlineplus.gov sidebar). (type “Alzheimer’s exercise” in the search bar) By exercising with the person whom you are caring for, not only are you both • National Center for Complementary and Alternative Medicine benefiting from participating in pleasant http://nccam.nih.gov activity, says the Mayo Clinic, you are spring 2008 www.ALZinfo.org 31 Long-term Planning By Bernard A. Krooks, Esq.

Elder Care Costs Can Be Expensive— 5 Steps for Planning Severe neurological conditions that affect memory leave a large burden for the caregiver. Planning ahead and taking some simple steps now can lessen that burden and improve the care you receive.

f I asked you for a defi- This care can be received at nition of estate plan- home or in an assisted living Ining, you might say facility, adult day care center, that it means making or a nursing home. sure that your loved ones Most people think that receive what you have these costs affect only the life worked so hard for during savings of the seniors receiv- your life when you pass ing the care. However, a sig- away. Some of you might nificant number of adult chil- even say it means making dren take care of their aging sure that the government parents, including paying the does not get any more costs of housing, health care, than necessary in taxes and incidental expenses. Costs from your estate when of clothing, home repair, and you die. Nevertheless, fo- cell phones can be unnoticed cusing on estate planning and often come out of the is about as desirable as go- pockets of the adult children. ing to the dentist for root Most children are not aban- canal work for many of us. doning their elderly parents Although it may weigh on but shouldering the signifi- our minds, there always cant time and financial bur- seems to be something Once you understand the facts, planning for den required to help them. more important to do like long-term care becomes much less daunting. This burden is compounded buying a new car or plan- by the fact that most people ning a family vacation. simply do not have any idea Surprisingly, there is something we nursing home before we die. Moreover, how much long-term care costs, and like thinking about even less than es- more than 50 percent of the people sur- they believe that Medicare pays this cost, tate planning and that is planning for veyed said that going to a nursing home which it does not. However, if we haven’t the rest of our lives and, in particular, is worse than becoming bankrupt and planned in advance, our life savings can planning for the possibility that we even worse than dying. be depleted since Medicare coverage of may get sick and no longer be able to This is unfortunate since annual long-term care is extremely limited. In take care of ourselves. According to long-term care costs nationwide aver- fact, even if you qualify, Medicare pays a recent survey by a major insurance age approximately $75,000; and in for only a couple of months of care if company, more than half of all people some major metropolitan areas, the you’re lucky. It will pay only 20 days would rather meet with an advisor to costs can exceed $150,000 per year. for “skilled nursing home care,” which discuss their will and estate planning Generally speaking, long-term care is occur after a hospital stay. Thereafter, than discuss planning for long-term the assistance needed by someone who there are significant co-payments. In care needs. This is true despite the fact can no longer independently perform some special cases, and these are lim- that approximately 50% of us over the daily activities such as eating, bath- ited, Medicare will provide home care age of 65 will spend some time in a ing, toileting, transferring, or dressing. services without a prior hospital stay. In 32 Preserving Your Memory spring 2008 these cases, the person must be home- 3. Understand Medicaid and Spou- Medicaid within five years of pay- bound due to their condition, require sal Protections: Generally, indi- ing for a grandchild’s education, intermittent (not full-time) skilled nurs- viduals become eligible for Med- then the grandparent may not be ing care, and the person applies directly icaid assistance once their assets eligible for Medicaid, and there through a Medicare Certified Home are below a certain level; (approxi- may be no funds available to pay Health Agency (CHHA). mately $2,000-$4,000). There for the grandparent’s care. Many theories abound attempting to are, however, special protections explain our apprehension about plan- for married couples, so that the 5. Discuss Different Planning Op- ning for long-term care and the rest of spouse living at home (the commu- portunities: Elder law attorneys our lives. While most Americans rec- nity spouse) has sufficient funds to are using strategies like irrevocable ognize the importance of planning for meet his or her needs. Generally income-only trusts to assist clients their possible long-term care needs, the speaking, the community spouse with long-term care planning. Prior emotions that surround the thought is entitled to keep non-exempt to the DRA, transfers to trusts were of losing our independence, as well as assets of up to $104,400. This is subject to a five-year, look-back pe- the misconceptions we may have about called the Community Spouse riod, while transfers to individuals care options, make it uncomfortable Resource Allowance (CSRA). In were subject to a three-year look-back for us to confront these issues. addition, the community spouse period. Now that the five-year look- Here are 5 steps to help explain the is entitled to monthly income of back period applies to all transfers, facts about long term care, so that up to $2,610. This is called the trusts should be given careful con- planning for the possibility of needing Minimum Monthly Maintenance sideration as a planning tool. Trusts it becomes much less daunting. Needs Allowance (MMMNA). provide more flexibility and more se- These amounts vary depending on curity for the senior than an outright 1. Define Long Term Health Care: which state we are talking about transfer to a child. In addition, trusts Long term care does not necessarily and may be increased through a offer tax advantages when compared have to mean nursing home care. fair hearing or court order. to an outright gift. Another plan- In fact, most care today is received ning technique might be to purchase at home. By planning in advance, 4. Be Familiar with Medicaid Look long-term care insurance to cover the you can keep more options avail- Back Rules: Prior to the passage of look-back period, in case you need able to you and make things easier the DRA, there were rules in effect nursing home assistance within five for you and your family. to limit asset transfers to children years after the transfer to the trust. and other persons. The DRA tight- 2. Know Your State’s Rules: Long- ened those rules. Previously, a per- Although the landscape has signifi- term care planning has always been son could transfer assets, and if the cantly changed since the enactment of a complex area of the law, and it has person applied for Medicaid within the DRA, planning opportunities re- become even more complex since the three years of making the transfer main to protect your assets. The earlier enactment of the Deficit Reduction (the look-back period), then the you plan ahead, the more assets that Act of 2005 (the “DRA”) on Febru- person would be assessed a pen- can be protected for you and your fam- ary 8, 2006. The federal government alty period based on the amount ily. Do yourself a favor; take the time oversees the Medicaid program, but of the transfer, with the penalty today to plan for the rest of your life. the program is administered by the period starting in the month after Although the process might involve a states. Rules can vary from state to the date of the transfer. Now, any significant amount of time and effort, state, and all states have not yet com- transfers made within five years and force you to confront some dif- pleted modifying their guidelines of applying for Medicaid will be ficult issues, you’re worth it. You and and regulations as a result of the assessed a penalty period, but the your family will be glad you did. ■ DRA. Although about three-quar- penalty period will not start un- ters of the states have implemented til the Medicaid applicant is in a Bernard A. Krooks, JD, CPA, LLM (in DRA, there remain many issues that nursing home, is otherwise eligible taxation), CELA, is president and founding still require further clarification. In for Medicaid, and applies for as- member of the NY Chapter of the National fact, we may not know the answers sistance. These rules could poten- Academy of Elder Law Attorneys and a na- to some questions until the courts tially cover gifts to grandchildren tionally known and widely quoted expert on have had a chance to review and to help pay for their education. If elder law. For more information, visit www. consider these issues. the grandparent needs to apply for littmankrooks.com. spring 2008 www.ALZinfo.org 33 Keeping Your Mind Sharp Brain-Boosting Puzzles BRAIN-BOOSTING CROSSWORDS “Use it or lose it.” The message is simple. If you don’t use your muscles, they will no longer be as effective as they should be. Of course the brain is not a muscle; however, it has recently come to light that “mental workouts” might help preserve memory and other mental skills. In these pages, we offer a variety of different types of puzzles that will give your various skills involving mem- ory, deduction, and letter manipulation a work out, and, we hope, also provide you with a ton of fun! (Answers on page 37)

MATCH THESE DROPLINE

LEAPFROG

•VISIT US AT KAPPAPUZZLES.COM•

34 Preserving Your Memory spring 2008 Brain-Boosting Puzzles BRAIN-BOOSTING CROSSWORDS “Use it or lose it.” The message is simple. If you don’t use your muscles, they will no longer be as effective as they should be. Of course the brain is not a muscle; however, it has recently come to light that “mental workouts” might help preserve memory and other mental skills. In these pages, we offer a variety of different types of puzzles that will give your various skills involving mem- ory, deduction, and letter manipulation a work out, and, we hope, also provide you with a ton of fun!

MATCH THESE DROPLINE

LEAPFROG

•VISIT US AT KAPPAPUZZLES.COM• (Answers on page 37)

spring 2008 www.ALZinfo.org 35 BRAIN-BOOSTING PUZZLES HIDDEN-MESSAGE WORD-FIND

SUDOKU

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36 Preserving Your Memory spring 2008 PUZZLE ANSWERS BRAIN-BOOSTING PUZZLES HIDDEN-MESSAGE WORD-FIND

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Links: AYP0705216_stethoscope_Final2_GS.eps, horizontalcolBW_V1.eps, AClogo_blk.eps A1049 Fisher-Dicksons ad.indd 1 1/18/08 11:54:56 AM Jenny Thompson. Eight Years Old. Big Sister. Avid Reader. Awesome Flute Player. Alzheimer’s Sufferer.

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

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

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

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

WORKING TO MAKE ALZHEIMER’S NOTHING BUT AMEMORY. FOR EVERYONE. Donate now for the cure. ALZINFO.ORG 1-800-ALZ-INFO

Zachary & Elizabeth M. Fisher Center for Alzheimer’s Research Foundation One Intrepid Square West 46th Street & 12th Avenue New York, NY 10036 SUBSCRIBE NOW!

Preserving Your Memory: The Magazine of Health and Hope 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. Over 5 million people currently suffer from Alzheimer’s disease. The Fisher Center Foundation recognizes a need to increase awareness of the disease as well as educate the public on Alzheimer’s research and patient care.

To subscribe to Preserving Your Memory, please see reverse side. Preserving Your Memory: The Magazine of Health and Hope Preserving Your Memory: The Magazine of Health and Hope Subscription Rates (U.S. Residents): $16 for one year (4 issues) Complete the information below, place in a stamped envelope along with check or Please help us increase awareness of the • Do you feel that this magazine has credit card information. Make check payable to Vitality Communications, and mail to: impact of Alzheimer’s on patients, their given you a better understanding of families and their caregivers by taking a Alzheimer’s disease? Y/N (circle one) Preserving Your Memory, c/o Vitality Communications moment to fill out this brief survey: P.O. Box 18427, Greensboro, NC 27419 • Which article in this magazine was • Are you: Male Female the most helpful to you? Or fax to: (336) 547-0768 (please circle one) Name: • Are you: • What other areas would you like 18-28 29-39 40-50 51-59 60-70 71+ Address: to see covered in Preserving Your (please circle one) Memory magazine? City: State: ZIP: • Do you know of someone with Alzheimer’s disease? Phone: ( ) Y/N (circle one) E-Mail Address: • Are you caring for someone with • Would you like to receive our free o Check (payment enclosed) o Please charge my: oVisa o MasterCard Alzheimer’s disease? e-Newsletter? If so, please provide Y/N (circle one) your e-mail address: Card Number: Card Expiration Date: Signature: Date Signed: