The SAGE Test

The big news this week on the brain front is the release of a medical doctor's in-home mental test to help determine if someone over the age of 50 may be cognitively impaired.

The Self-Administered Gerocognitive Exam (SAGE) is designed to detect early signs of cognitive, memory or thinking impairments. Those who miss 6 or more questions on one of four forms of the test are instructed to bring the results into their primary care physician.

One reason this test is being given so much media attention is because it originates with Ohio State Univeristy Medical Center's director of cognitive neurology division, Douglas Scharre, M.D.

"What we found was the SAGE self-administered test correlated very well with detailed cognitive testing," he said in a prepared statement. "If we can catch this cognitive change really early, then we can start potential treatments much earlier than without having this test."

Surely among the pluses is the test itself - requiring just pen and paper (and the Internet if you wish to download it from online). You then bring the results to your health care provider for evaluation. There is no answer sheet provided. The 22 questions range from "What is today's date?" to "How many nickels are in 60 cents?" and involved different forms of thought. By not knowing if you passed or failed, more people may make an appointment with their doctor on this subject instead of tacking it on to another scheduled appointment.

According to the Web site: "It is normal to experience some memory loss and to take longer to recall events as you age. But if the changes you are experiencing are worrying you or others around you, SAGE can be a helpful tool to assess if further evaluation is necessary.

Unfortunately, many people do not seek help for these kinds of symptoms until they have experienced them for several years. There are many treatable causes of cognitive and thinking loss, and in some cases, medications or other treatments can be very effective-especially if provided when symptoms first begin."

That may be one of the biggest benefits of SAGE and other self-administered tests to follow. Most people wait years - until someone else urges them to see a doctor about their forgetfulness or behavior - to seek help for a memory impairment. By then the damage may be irreversable (depending, of course, on the cause).

Just as the "cure" for cancers will not be a pill or a procedure but a permanent change in lifestyle to reduce risks and detect cellular mutatiions and tumors earlier, so too with brain health does it make a big difference if you do things in your everyday life to improve your odds of a brain healthy, long life.

Remember to eat well, exercise daily, not watching too much television (and instead read! read! read! either by book or by CDs), socialize and adopt healthy strategies for dealing with serious stress and depression.

You can also dowload the test.  

Does Chronic Stress in Middle Age Later Lead to Alzheimer's?

We now know that while there isn't a cure for Alzheimer's, but there are certain risk factors that raise the chances -- and brain-healthy lifestyles that reduce the risk. They include exercising regularly and moderately, eating well, keeping the brain active and staying socially connected.

If a new Swedish study is any indication, we may want to add reduce your daily stress level to that list.

The study followed 800 women ages 30s through 50s for almost four decades and discovered those that who dealt (perhaps poorly, perhaps long-term) with severe or chronic stress from, say,a divorce, a longterm job loss, a spouse's death, a child with substance abuse were more likely to show symptoms of dementia (particularly Alzheimer's disease) in their later years. In fact, those who underwent stressful periods or learned to live with an elevated level of stress

"That doesn't prove that a stressful life is to blame, said Dr. Marc Gordon, chief of neurology at Zucker Hillside Hospital in Glen Oaks, N.Y.  But, he noted, the researchers did account for a number of other explanations for the link -- including whether the women had high blood pressure or diabetes, were overweight or had low incomes."

The idea of a link between stress and dementia is not a stretch. When we're stressed, our body chemistry changes and that impacts our diets, our sleeping patterns, our relationships with others, etc. In other words, it circles back to the lifestyle choices we mentioned earlier - eating well, exercising and staying connected to your friends. Caregiving is stressful in general, and elder caregiving particularly so.

What the study does suggest is that even those who live with chronic stress may be at higher risk if they don't treat the stress (and possible depression) that comes with sudden life changes or chronic conditions.

"These are the kinds of stressors that grate on people day to day," Wilson noted. And this study, he said, suggests that these issues should not "just be brushed off." He agreed, though, that the question remains: Could stress reduction make a difference in people's Alzheimer's risk?
 

The jury's still out on that, but in the meantime, the best way to handle life's lumps is to change what you can and accept what you cannot. If you find you are not eating properly, sleeping properly or maintaining important relationships because you're always stressed, it may be time to get professional help now to improve your prospects in the future.

Are You Being Emotionally Manipulated?

Last week the Caregiver Coalition of San Diego County presented a forum on elder abuse. Each of the speakers gave great information on how to detect abuse or neglect and what steps to take once it is suspected.

One of the most difficult forms of elder abuse is financial abuse, which in 80% of cases involve a family member, often struggling with substance abuse or a gambling addiction, who takes advantage of a senior relative and drains their savings and income, said Det. Ferrell Layton, who handles the elder abuse unit for the San Diego Police Department.

Similarly, seniors can be easy prey for scam artists, who have become quite adept at getting the elderly to “buy into” overseas lotteries or wire money to bail out a grandson in jail in Mexico or Canada (and who sounds “funny” because they broke their nose in a car crash. . .).

Dr. Diane Darby Beach, director of education for Vista Gardens Memory Care, said the most likely victims of undue influence and manipulation are those who are lonely, depressed or anxious. Conversely, overly stubborn and arrogant individuals also are more susceptible because predators know how to appeal to their ego.

Here are some of the warning signs of undue influence, especially if the victim is physically or mentally impaired:

• After only a brief relationship, someone becomes a confidant and systematically isolates a senior to keep them away from other family and friends
• Intercepting phone calls and mail
• Taking a victim on an unexpected trip to further isolate them and also to create a new situation and environment that makes them more vulnerable

Emotional manipulators often:

• Say “I’m sorry you feel that way” instead of apologizing with “I’m sorry”
• Want to be more and more involved in your life
• Promise one thing and later deny ever saying it
• Make someone feel guilty for speaking up – or not speaking up enough
• Talk behind someone’s back to get others to say what they won’t say themselves
• Have no sense of accountability and believe it’s always about what everyone else has done to them

How do you protect yourself or a loved one or friend from undue influence?

• Stay connected and make sure seniors who are vulnerable to manipulators stay out of isolation as well.
• Get more involved in someone’s life and get others involved
• Consider contacting police or adult protective services if such abuse is suspected
• If legal action is called for, make sure the hired attorney is trained in elder abuse and undue influence

And if you are a professional who wants to learn more about elder abuse and neglect, consider signing up for the upcoming Glenner Symposium on Elder Abuse & Neglect on Friday, June 7 at Sharp Spectrum Auditorium. It’s designed for professionals who currently or contemplate having senior-aged clients and patients. Learn more at www.glenner.org/symposium.

Go Ahead and Have a Good Cry

Reprinted with permission by Dr. Mario Garrett

There is a hint of disgrace associated with crying, especially among older men. The stigma is not surprising since most scientific studies attempt to associate crying with depression. In fact, among older adults, depression is often not related to feeling sad. What emerges is that we know very little about crying. Not only is there no clear-cut association that crying is a sign of depression, there are also very few studies reporting the opposite—that crying has healing benefits, when crying is not a response to pain or anger.

A popular view is that crying can have a positive psychological as well as a physical benefit, a view shared in popular literature. In a review of 140 years of popular fiction, crying is promoted not only as beneficial, but most warned readers that keeping back tears would harm them. Even Hollywood knows this and makes money selling us tearjerkers.

Lauren Bylsma now with the University of Pittsburgh, and her colleagues reported that when 4,000 men and women in more than 30 countries were asked about crying, most people—in retrospect—reported improved mood, reduced tension and feelings of relief after crying. But this report of benefits from crying is not repeated in a laboratory setting. When adults are made to cry in response to a sad film, report feeling worse—increased sadness and distress—than those who did not cry. Of course it could be a matter of timing. Using another example, people are more likely to report being relaxed an hour after jogging than immediately after. And the same might be the case with crying. There might be a time lag in reporting positive effects from crying.

And what about gender differences? Women cry more often and more intensely than men, although both report equal benefits. Interestingly what researchers have found is that people who suffer from alexithymia—the lack of understanding of emotions—reported fewer episodes of crying and reported less positive mood benefits as a result of crying.

What is missing from these analyses is the fact that crying can be a social behavior. Many of us cry, some privately and infrequently, others more consistently and publicly. In some cultures there are criers who are paid to cry at funerals. There is a social context as well as a psychological one. Crying is also a learned behavior. Men are taught not to cry from an early age, while women elicit support and compassion when they cry. Social crying might be a form of social behavior in order to elicit empathy from others. And the cues of crying are so strong that even dogs express empathy when strangers are crying.

Crying among older adults is complex. There is evidence of benefits but it depends on who you are. If you are a happy person you gain more from crying than if you are a sad person, if you empathize you are more likely to benefit. There is also a positive social component to crying that women might have been exposed to more than men. The benefits of crying might reflect more who you are than what you are emotional about.

Mario Garrett, Ph.D., is a professor of gerontology at San Diego State University and can be reached at mariusgarrett@yahoo.com

A Group Where Support is All Sewn Up

During this month’s cultural competency conference sponsored by the County of San Diego Health and Human Services Agency, we had the pleasure of meeting members of the Pauma Valley-based Indian Health Council and learned about a unique support group that brings together otherwise isolated adults, particularly seniors, to help them process personal issues.

The “Stitch to Wellness” program is the brainchild of Cori Owen-Biggs, BSW, a case manager in the IHC’s Tribal Family Services Department. Two years ago Cori discovered a way to explore mental health issues in a non-threatening manner: creating a quilting circle and providing space and materials so that anyone in the community could attend.

Cori, who describes herself as having “two left thumbs,” nonetheless bought herself a quilt kit when the group first launched and joined the women as they showed up with their sewing machines at the Council building to create works of art inspired by field trips to quilt shows and their own ancestry.

Initially the group was small and not talkative, but overtime both the size and the conversations grew. The scope of the work expanded too to include beading and other crafts. Soon the women began to open up about their personal hardships.

“They didn’t realize that they were healing themselves,” Cori said. “What we gave them was a place to talk without someone breathing down their throats. It allowed them to talk about something so hard that they otherwise would keep bottled up inside them.”

In addition to helping the women manage their grief and depression and improve their overall well-being, they also were encouraged to reach out with what they learned in the group to other isolated members. For instance, one month they may learn about post-traumatic stress disorder or anger management. In another, it may be home safety.

There is another byproduct of these weekly wellness meetings at the Rincon Clinic on Wednesdays and Santa Ysabel Clinic each Thursday.

The quilts made by the Stitch to Wellness sewing circle are donated to foster youths and their families or raffled off at special events to benefit groups like local veterans. In that way, the giving continues and the wellness grows.

May each of you find your own ways to support each other through difficult times in the year ahead.

7 Steps to Forgiveness

We just returned from a two-day regional mental health conference sponsored by the County of San Diego Health and Human Services Agency. Among the many great panels and discussions was one led by Sharon Adams, Ph.D., on “Cultural and Personal Forgiveness.”

We all encounter people who cross us or bring us harm in our work lives, our personal lives and throughout societies. They may even be the very people for whom we now are caring for in their advanced age or diminished state. And if we can't forgive them for what they've done, we should forgive them for what they continue to do. Chronic “unforgiveness” has been linked to numerous health issues – including obesity, substance abuse, depression and anxiety. That’s why it’s important to learn to forgive, not for the people who hurt or offended you but for yourself.

 “Forgiveness is a choice. It’s an act of your own free will,” Adams, who is Dean of Student Services at Sierra College, told the crowd gathered at the Hilton in Mission Bay. “It is an act of emotional release that brings some level of closure and peace. It also is a process – it doesn’t happen right away.”

"People who have a hard time forgiving others have a hard time forgiving themselves,” she said. It’s important to understand that to truly forgive does not mean you forget or condone what someone did. You don’t even have to try and like that person again. You are merely deciding you no longer want to spend any more energy on the issue.

Forgiveness also doesn’t mean instant relief; the anger can dissipate over time and you’ll know you’ve truly forgiven someone when you have no need to bring them harm in anyway.

Here are 7 steps Adams outlined to reach a full state of forgiveness:

1. Acknowledge that forgiveness is a choice. The single most important issue we will settle in our lives is whether or not we will choose to forgive.

2. Be willing to embrace a new normal. Some of us become consumed with revenge and reshape our lives and goals because of it; letting it go can open up other opportunities.

3. Empathize with your offender. Many of us are capability of the same kind of cruelty on a different scale. Understanding where someone’s anger or hate may come from is important.

 4. Forgive yourself, if necessary. Self-blame, especially when it comes to chronic abuse, is common.

5. Chose not to keep a record of wrongs. Doing so only makes it more difficult to let it go. If you constantly catalog and resurrect all of the insults, slights or assaults, you will never lead a full life.

6. See the offense as an opportunity for personal growth. Your creativity will improve, as will your mental health.

7. See you God in your offender. Everyone starts off as an infant with no malevolence but have something happen to them at some point in their lives. Most abusers and bullies have been abused and bullied themselves. It can be important to recognize they weren't born this way.

Adams ended her presentation by reminding us that “truly healthy people” get back to being centered sooner.

Depression Hurts Everyone in the Family

Caregivers of dementia patients have a high rate of depression. One survey by Caring.com puts the number at 25 percent, while the Alzheimer’s Association’s most recent report puts that figure at 33 percent.

At some point in the journey, caregivers become overwhelmed with their current circumstances. Sometimes that continuous worry leads to stress, and that unabated stress can become depression. This, of course, has an impact on the level of care they can provide to their memory-impaired spouse or parent. But what isn’t typically talked about in this context is the toll untreated depression can have on the caregivers’ children. This is particularly true of adult children who are caring for a parent while being a parent to younger children.

According to an article in The Wall Street Journal, untreated depression in mothers and fathers can lead to a similar condition in their children.

"These findings should alert us. If you have the disease, get into treatment, because it can have a big impact on your family," says psychiatrist Madhukar Trivedi from the University of Texas Southwestern Medical Center in Dallas, a co-author of the study. Only about half of people who fit the criteria for major depression get treatment, he says.

The George G. Glenner Alzheimer’s Family Centers began in 1982 to help caregivers cope with their daily stress by offering a place for their loved one to socialize and be supervised for a few hours or a full day. And while the WSJ piece focuses on post-partum depression, a similar condition can develop with those caring for memory-impaired elders. If some of the following symptoms last more than two weeks, you should seek professional help – if not for your own good, then for your family’s.

• Feelings of guilt or worthlessness
• Irritation and agitation
• Inability to sleep well
• Constant fatigue
• Loss of interest in normally fun activities
• Decrease or increase in appetite or weight
• Suicidal thoughts or actions

Sources:
Alzheimer's Caregivers Biggest Health Risk
Alzheimer's Caregivers' Heavy Toll

Taking Care of the Caregiver

Earlier this week Dr. Marc Ringel appeared on a Colorado public radio station in a piece called “The Hardest Job There Is.” It was about the physical, mental and emotional toll of caring at home for someone with Alzheimer’s disease. It’s a piece that every primary caregiver – and right now there are 10 million of them across the U.S.A. – can relate to.

Consider this passage:

Out of love, and sometimes for financial reasons too, people make the most amazing efforts to keep demented elderly out of institutions. In early stages of disease, there may be no more challenge than to keep an eye on a forgetful housemate some of the time. The need for supervision will inevitably progress as confusion and wandering come into play, to the point that a competent person needs to be present 100% of the time.

Caring for the Caregiver also was the theme of last week’s Town Hall Forum in San Diego. Among the speakers was Alejandra Ceja-Aguilar, director of education and outreach for the Southern Caregiver Resource Center. This week we’re going to feature some of her tips to help caregivers stay well themselves so that they can be of benefit to those who depend on them.

Four Steps to Help Reduce Caregiver Stress

1. Recognize the Warning Signs of Stress
Trouble focusing
Difficulty making decisions
Change in sleep habits
Feel overwhelmed
Feeling edgy and irritable
Becoming isolated
Consuming sleeping pills, alcohol or caffeine
Feeling hopeless or helpless

2. Identify the Stressors Individually
Do you feel angry when you can’t go for a walk because there’s no one to look after your father? Do you feel tired in the mornings because you couldn’t sleep the night before?

3. Explore Potential Solutions to Each Stressor
Ask for help and accept help. People want to do it and you must recognize you need the help. Be specific and clear with your requests, such as asking a neighbor to stay with your mom while you run to the grocery store.

4. Implement a Solution That Will Work for Each Stressor
Remember to focus on each stressor individually; the entire picture can be quite scary.

Always remember that you cannot change the condition, only the way you respond to it.

KUNC Audio/Transcript: The Hardest Job There Is

Exercise: It Does a Body (and Mind) Good

Program Aide Cora at our Encinitas Center leads a lively exercise session.

Health care professionals have long known that regular exercise carries many physical, mental and emotional benefits. Researchers continually show us that, among other benefits, exercise helps mitigate and perhaps even alleviate depression. That’s also true of those with Alzheimer’s Disease, where as many of 87% of older AD patients suffer some form of depression, according to Clinical Gerontologist.

At our Glenner Centers in Chula Vista, Hillcrest and Encintas, daily exercise is encouraged through walks around our facilities and chair calisthenics. Researchers at Florida Atlantic University explained in one study why exercise may be so important to AD patients:

There is a great need for non-pharmacological interventions for depression in moderate to late stage AD. These individuals are less able to participate in talking therapies and more at risk for adverse effects of antidepressant medications than are other depressed older adults.

It's important to note that caregivers, too, can help stave off depression and remain physically and mentally healthy through daily exercise as well.