Patients And Caregivers Unprepared For The Mental And Behavioral Changes Associated With Parkinson’s Disease

Parkinson’s disease affects 6.3 million people worldwide. While the disease is recognized for its profound effects on movement, up to 40 percent of Parkinson’s disease patients also develop changes in thought, behavior and judgment.

As Parkinson’s disease progresses, patients may experience what is called ‘Parkinson’s Psychosis,’ in which they experience changes in thought, behavior and judgment. In more advanced stages these symptoms include hallucinations where patients see, hear or feel things that aren’t really there, and paranoid delusions where they become distrustful of even their closest friends and family members. The emergence of these symptoms represents a major turning point in the course of the patient’s disease.

“While the physical manifestations of Parkinson’s disease are difficult to deal with, the changes in thought, behavior and judgment strain the bonds between patients and their caregivers and families,” said Dr. Bernard Ravina, Director of the Movement and Inherited Neurological Disorders Unit at the University of Rochester in New York.

According to an on-line survey recently conducted by MediciGlobal, a global patient recruitment and retention specialty firm, over one-third of Parkinson’s caregivers are unaware that changes in thought, behavior, and judgment can accompany the disease. “As a registered nurse, I was prepared for the physical problems with my husband’s Parkinson’s disease but, despite my job as a RN, I was totally unprepared for the psychiatric issues,” said Carol McLain, a caregiver who took the survey.

According to Dr. Ravina, “It’s the non-physical symptoms of the disease that are often most devastating for both the patient and caregiver. As the patient’s mental health deteriorates, the family often has to make the painful and expensive decision of moving the patient into a nursing home.”

There are currently no FDA-approved treatments for these particular non-physical symptoms of Parkinson’s disease. Nevertheless, doctors often resort to the use of potent antipsychotic drugs to treat these symptoms even though these drugs sometimes have serious side effects, particularly in the elderly, including worsening of motor skills, excessive sleepiness, increased infections, stroke, and sudden death in some patients. As a result, there is a large unmet medical need for new and improved treatment options.

Home Care Versus Nursing Home Care

Most elders would prefer to stay in their own homes, where they know their neighbors and can associate memories with each piece of furniture and object around them, rather than move to an institution as they age.

Things that can make “aging in place” — the current term for staying in one’s own home as one ages — problematic are tasks such as cooking, cleaning, toileting, shopping, doing laundry, and driving, as well as falls, which for frail elders could initiate a downward spiral.

Support systems

• Help could come from family members, friends, or neighbors, who take care of the specific thing the elder has trouble with — such as doing laundry or shopping.
• Or, some elders turn to their religious community, as often there are volunteers willing to enable a senior to age in place.

• Home care agencies can be hired to provide the extra help needed for the senior to be able to age in place. In some cases, expenses will be reimbursed by Medicare, but seniors will need to check with the home care agency to find out about this possibility.

New technology can help seniors

• Electronic devices are now available to help monitor whether or not a senior has taken his or her medication — and if not, to remind the senior — or to determine whether a senior has opened the refrigerator.
• Emergency buttons can be worn around the neck and pressed if a health or other emergency should occur, in which case a person will speak to the senior through the device, assess the situation, and call for appropriate help.
• Cameras can be installed to track a senior’s movements, allowing adult children to monitor the senior and be assured that he or she is functioning well.
• New devices are constantly being invented, and they can make an enormous difference in a senior’s ability to age in place.

With all of these options available, aging in place is an increasingly viable choice. Seniors and their loved ones need to assess whether this alternative is indeed best, the risk being that the senior may become too socially isolated despite being in familiar neighborhoods and homes.

Antipsychotic Drugs Increase Risk of Death Among Elderly

The FDA has ordered the makers of older, “conventional” antipsychotics to add a “black box warning” to the drugs labels about the risk of early death in elderly dementia patients who take them. This is the strongest warning that can be placed on a medication without pulling it from the market.

This marks the first time that the FDA has used its new authority to mandate stronger warning labels on drugs. Before 2007, the FDA only had the power to request changes to warning labels.

The FDA concluded that conventional antipsychotics pose the same risks to elderly dementia patients as the newer, so-called “atypical” antipsychotics.

“The warning for both classes of drugs will say that clinical studies indicate that antipsychotic drugs of both types are associated with an increased risk of death when used in elderly patients treated for dementia-related psychosis,” the agency said.

In 2005, atypical antipsychotics received a black box warning after studies found that they increased the risks of heart attacks and pneumonia among elderly dementia patients, and that patients who were given the drugs died sooner than those who were not. In one such study cited by the FDA, 50 percent of elderly dementia patients died after ten weeks of treatment with the drugs, compared with only a 2.6 percent death rate among those taking a placebo.

Antipsychotics were designed for the treatment of schizophrenia, and are not approved for the treatment of dementia. Nonetheless, doctors are allowed by law to prescribe according to their own judgment, and antipsychotics are often used to sedate elderly dementia patients who develop psychosis-like symptoms, such as aggression, agitation, hallucinations or delusions.

Many patient advocates have accused many nursing home staff of shortening patients’ lives by giving them drugs that are only designed to sedate, rather than treat them

Grandmothers Raising A Grandchild Should Not Neglect Their Own Health

Precautionary health measures such as mammograms and cholesterol tests that identify the risk of heart disease are critical for the well-being of women over 50. Add the responsibility of providing sustained care for a grandchild, and these preventive examinations become even more important.

Yet, grandmothers in the first two years of caring for a grandchild take fewer preventive measures to protect their health compared to grandmothers the same age not raising children, according to a recent USC Davis School of Gerontology study.

According to the study, the number of custodial grandparents in the Unites States has nearly doubled since 1970, creating an emerging public health concern.

“Given that this group is already at risk for poor health outcomes because of their advanced age and vulnerability to chronic conditions, poor preventive behavior might precipitate a decline in health over time, a situation which could render the grandmother unable to care for her grandchild,” explained lead author, Lindsey Baker, a postdoctoral fellow at the USC Davis School.

In a recent paper in the Journal of Gerontology, Baker and co-author Merril Silverstein, USC professor of gerontology and sociology, looked at five types of protective health behaviors: influenza vaccination, cholesterol screening, monthly breast self-examination, mammography and Papanicolaou tests, or Pap tests, used to identify risk factors for cervical cancer.

Their findings indicate that grandmothers in the early stages of caring for a grandchild were significantly less likely than grandmothers not raising grandchildren to undergo flu vaccination or cholesterol screening. They were also less likely to get Pap tests, the researchers found.

However, after two years of caring for a grandchild, what was once a health burden becomes a potential health benefit. Baker and Silverstein found that caregiving grandmothers were increasingly health conscious once they made the transition into full-time care, becoming more likely than those not raising grandchildren to adopt preventative health measures such as flu vaccinations and monthly breast self-exams.

Elderly Cancer Survivors’ Ability To Function Improved By Home-Based Interventions

Climbing stairs, carrying groceries, taking a shower – these are activities that we take for granted; however, after a cancer diagnosis, many survivors are unable to function as they used to. Home-based diet and exercise interventions may improve physical functioning in older, long-term cancer survivors, according to data presented at the American Association for Cancer Research’s Seventh Annual International Conference on Frontiers in Cancer Prevention Research.

Participants were randomly assigned to an intervention or a wait-list control group. Those in the intervention group received tailored mailed print materials on diet and exercise, a pedometer and exercise bands. For the first three weeks, participants received weekly phone calls, which tapered off to every two weeks and then once a month until the end of the study.

At the end of one year, researchers evaluated physical function, diet quality and physical activity using standard measures. Participants in the intervention group demonstrated significant improvements in their diet and exercise behaviors, and their weight status. What’s more, according to the SF-36 physical function test, participants in the intervention group had a 2.5 point decline compared with a 5.3 point decline in the control group. Similar differences were seen in measures of basic lower extremity and advanced lower extremity functioning. Overall, the magnitude of effect was similar to preventing physical function losses comparable to that imposed by ischemic heart disease.

The ability to perform moderate to vigorous physical activity improved as well. In the intervention group, participants increased their ability by 44.9 minutes a week compared with 29.7 minutes per week in the control group.

Body mass index declined by 0.8 in the active group compared with 0.3 in the control group.

“Last year alone, we spent $219 billion on cancer care, but only 40 percent of that was spent on treatment,” said Demark-Wahnefried. “The majority of costs were due to lost productivity and health problems that surfaced afterwards.”

Walgreens Offers Assistance In Sorting Through Changes To Medicare Part D Plans

The six-week open enrollment period for Medicare Part D is under way and seniors are facing the annual task of evaluating prescription plans to nail down their choices for the coming year. Medicare enrollees have until Dec. 31 to review their current plan for any changes in cost or coverage and make certain it still meets their needs. Again this year, Walgreens pharmacists will be one of the best resources for Medicare information, offering a free personalized report that makes it easier for seniors and caregivers to weigh their options.

The report is available in minutes at any of the more than 6,500 Walgreens pharmacies nationwide or online at Walgreens.com/medicare. Pharmacists will enter a list of the patient’s medications and generate a printout detailing each plan’s estimated annual costs including monthly premiums, brand and generic co-pays and coverage through the coverage gap or “donut hole”.

“We urge people not to assume their plans will remain the same for 2009,” said Kermit R. Crawford, Walgreens senior vice president of pharmacy. “Many plans have made significant increases in premiums or changes to medications covered. Our report simplifies the decision-making process by providing information tailored for each individual in a way that makes it easy to compare options.”

Even if there have not been changes to their current plan, seniors are encouraged to consider how their needs may have evolved over the year and how their plan measures up against others available. Walgreens also recommends that seniors who switch plans or those enrolling in Part D for the first time do so well before the Dec. 31 deadline in order to ensure processing is complete before they need to refill prescriptions in early January.

Walgreens pharmacists can also help seniors determine whether they may qualify for the Extra Help subsidy. Patients who meet certain income requirements may be eligible for lower co-payments.

For more information on the personalized report and Medicare Part D counseling services available at Walgreens, contact your local store or go to http://www.Walgreens.com/medicare.

Doctors Worst Nightmares

Ever wonder what doctors have nightmares about? Perhaps it’s about giant bottles of vitamins stealing their patients! Vitamins, you see, help keep people healthy and prevent disease, and that reduces the repeat business for doctors. And I’m not talking about those cheap, chemical-based store-bought multivitamins you got on sale at the local Wal-Mart; I’m talking about quality vitamins with ingredients like methylcobalamin (high-grade vitamin B12), natural vitamin E, CoQ10, and easily digestible minerals like magnesium malate.

Of course, not all doctors are afraid of vitamins and dietary supplements. In fact, most doctors actually take at least one dietary supplement, and it’s a little-known fact that doctors often take vitamins even when they refuse to tell their patients to take them! Why is that? Because prescribing vitamins can get you in trouble with the state medical boards, almost all of which are run by Big Pharmacy sympathizers. Any doctor they discover to be prescribing dietary supplements gets targeted to have their medical license stripped away.

Calcium supplements reduce risk of fractures in elderly by 24 percent

Taking a daily supplement of calcium can reduce the risk of fractures in people over the age of 50 by 24 percent if a large enough dose is taken, according to a study conducted by researchers from the University of Western Sydney and published in the medical journal Lancet.

The researchers conducted a meta-analysis of 17 different studies that examined the relationship between calcium supplementation and the risk of fractures in people over the age of 50. Among the total of 50,000 people that the studies looked at, the risk of fractures was 12 percent lower among those who were given calcium supplements, and 24 percent lower among those who were given a daily dose of 1,200 milligrams.

The study’s results caused lead author Benjamin Tang to conclude that even among those who take calcium supplements, many are not taking them regularly enough or not taking a large enough dose.

“Unfortunately, most of the tablets are low dosage,” he said.

According to Tang, people over the age of 50 should be supplementing with at least 1,200 milligrams per day.

A small number of study participants suffered a side effect of minor stomach upsets. Tang cautioned that because most of the data analyzed by the research team came from studies on women, who are much more likely to suffer fractures or osteoporosis, the effects or side effects for men may be different.

Approximately one in six women suffer a bone fracture after the age of 50, compared with approximately one in 20 men.

Use of Bright Lighting May Improve Dementia Symptoms

The use of daytime bright lighting to improve the circadian rhythm of elderly persons was associated with modest improvement in symptoms of dementia, and the addition of the use of melatonin resulted in improved sleep, according to a study in the June 11 issue of JAMA.

“In elderly patients with dementia, cognitive decline is frequently accompanied by disturbances of mood, behavior, sleep, and activities of daily living, which increase caregiver burden and the risk of institutionalization,” the author writes. These symptoms have been associated with disturbances of the circadian rhythm (the regular recurrence, in cycles of about 24 hours, of biological processes or activities). “The circadian timing system is highly sensitive to environmental light and the hormone melatonin and may not function optimally in the absence of their synchronizing effects. In elderly patients with dementia, synchronization may be [diminished] if light exposure and melatonin production are reduced.”

Rixt F. Riemersma-van der Lek, M.D., of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, and colleagues conducted a trial at 12 elderly group care facilities in the Netherlands that evaluated the effects of up to 3.5 years of daily supplementation of bright light and/or melatonin on a number of health outcomes, including symptoms of dementia and sleep disturbances. The study included 189 facility residents, average age 85.8 years; 90 percent were female and 87 percent had dementia.

Six of the facilities had bright lighting installed in ceiling-mounted fixtures. Lights were on daily between approximately 9 a.m. to 6 p.m. Participants were randomized to receive evening melatonin (2.5 mg) or placebo and participated an average of 15 months (maximum period of 3.5 years).

The researchers found that bright light lessened cognitive deterioration by a relative 5 percent, reduced depressive symptoms by a relative 19 percent and diminished the gradual increase in functional limitations by a relative 53 percent.

Melatonin reduced the time to fall asleep by a relative 19 percent and increased total sleep duration by 6 percent, but adversely affected caregiver ratings of withdrawn behavior and mood expressions. The addition of bright light improved the adverse effect on mood. In combination with the bright light, melatonin reduced aggressive behavior by a relative 9 percent.

“In conclusion, the simple measure of increasing the illumination level in group care facilities [improved] symptoms of disturbed cognition, mood, behavior, functional abilities, and sleep. Melatonin improved sleep, but its long-term use by elderly individuals can only be recommended in combination with light to suppress adverse effects on mood. The long-term application of whole-day bright light did not have adverse effects, on the contrary, and could be considered for use in care facilities for elderly individuals with dementia,” the authors write.

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