Decisions, Decisions, Decisions!

Posted on by Margi Oksner

I’m on the horns of a dilemma.  I’m revved up and raring to go to Sex, Aging and Memory, Canada’s first women’s brain health conference being held on October 18, 2011 at the Allstream Centre in Toronto.  I’ve got my registration form in front of me and all I have to do is choose two out of eleven great breakout sessions.

And that’s where I need some help – the choices are amazing.

Yesterday I spent three hours with my mother – stressful is an understatement.  I worried about her physical frailty as we walked from my car to the house; I worried about her mental frailty when I answered the same question for the 100th time; I  worried about her nutritional health when she was confused about what she was eating; and worst of all, I worried about her emotional well being because maybe she could sense that I couldn’t wait to take her home. 

With all that said, here’s the dilemma.  Should I take advantage of Tiffany Chow’s session on Stress and the Caregiver?

But, then I think, maybe I would be better off going to take part in Norman Farb’s session on the Mindful Brain to learn some meditation techniques and how mindfulness can be a good tool for me as a caregiver.

Or, should this not be so much about my dealings with my mother and more about what I can do for me now so that I might stave off
dementia as I age?

Maybe you can help me?  Check out the roster of great speakers and give me your opinion on what you think are the sessions I should attend. 
You can find the list at www.womenofbaycrest.com/brainhealth.

I need all the help I can get!

Margi Oksner

 

Lunch with Frida

Posted on by Margi Oksner

On Sunday, we took mom on an outing.  I have a friend who refers to it as the weekly airing out of the old.  She may be right.

Lunch with mom is a very different affair than it was even a year ago.  It’s no longer the three of us, Frida, my sister Fran and me – now it includes my mother’s constant companion – her caregiver – our godsend.

In the old days, lunch with Frida, was fun.  Frida was a notorious gossip.  She had a story to tell about every single person in her condo community and she was not particularly kind. Making eye contact at lunch was really difficult because Frida’s laser gaze was focused on the door to see who was coming into the restaurant that she might know.  Now, lunch with Frida is work, very hard work.

Fran and I are like a comedy routine – I’m sure other children of a parent with dementia have experienced this – the constant stream of chatter and retelling of funny stories and inane details directed more at the caregiver to amuse and entertain, because silence is the enemy and mom is not following the conversation.  By the time lunch is over, I’m exhausted, as though I’ve run a marathon – and it’s only been 45 minutes of keeping up the prattle and I’m in a sweat.

In the old days when we dropped mom after lunch, we would immediately call each other in our separate cars – to marvel at her comments, her attitudes, her perceptions, her criticism. We were not particularly kind (it’s genetics). We still make the call as soon as she’s out of the car, but now we use our drive home to assure each other that she is well cared for, that she loved being out at one of her favourite restaurants, that we are so lucky that she is physically well – we are very kind.

Margi Oksner

Having a great time! Wish you were here.

Posted on by Margi Oksner

Did you miss me?  I’ve been AWOL from my blog.  I could tell you that I was off on some exotic extended vacation – but truth be told – my crazy life just got in the way.

I have so much I want to share with you, the most important is SAM: Sex, Aging and Memory – Canada’s first women’s brain health conference.  SAM is growing in leaps and bounds.  SAM is right up there for excitement next to the birth of my own children.

Here’s the latest you need to know about SAM

  •  www.womenofbaycrest.com/brainhealth for details and registration.
  • The roster of speakers and breakout sessions is amazing.
  • The list of Honorary Chairs – women we all admire and revere – who want to be associated with SAM is growing daily (check out the list under the Committee Tab of the website).
  • Breakfast and Lunch – will be brain-healthy selections from our soon to be released cookbook – Mindfull.

I’m pumped.  October 18 is just around the corner so I’m already on the hunt for comfortable yet fabulous shoes for a day that will start early, end late and stimulate my mind at the Allstream Centre at Exhibition Place in Toronto (yes, even the old Automotive Building can get a face lift that’s too gorgeous for words).

I will keep you up to date on all the developments – and there will be many to share.

 Margi Oksner

Living in the Shadow of Alzheimer’s – Caring for a Loved One with Alzheimer’s

Posted on by Women of Baycrest

Tobie Seligman’s mother used to be very social. She always cooked and her home was open for anyone to visit at any time. Today, her mother sits at a family dinner in silence wrapped up in her own little world and has no friends. At the age of 80, her mother was diagnosed with Alzheimer’s disease, the most common form of dementia. “She started forgetting things like taking her medication. She would take money out from bank and forget where she put it. I no longer felt comfortable with her living at home alone,” said Seligman.

Seligman says her life was turned upside down with news of her mother’s diagnosis. Her once independent mother could no longer drive and was now dependent on her to keep track of appointments and to get her there and back. What was more stressful was watching her mother change. “I would often drop her off and start crying. I could cry every day but I try not to.”

With approximately half a million Canadians suffering from Dementia, Seligman is just one of the thousands of people struggling with the demanding responsibilities of caregiving. Most caregivers are women and according to the 2010 Shriver Report on Alzheimer’s more than half of them report serious emotional and physical stress as a result of caring for their loved ones.

Unsure of what to do and how to cope, Seligman joined a support group at Baycrest, an academic health sciences centre with a focus on Brain Fitness. It was an opportunity for her to hear from others in a similar situation and learn from their experience. “We did a lot of talking and it really helped. It changed my life. I learned that I was not alone and got stronger as it went along.”

Life improved for Seligman, she says, when she hired a live-in caregiver for her mother. “It was the best thing that ever happened to us. I got my life back.” Seligman began to work more and to exercise. She took guitar lessons and took advantage of opportunities to talk about it and take care of herself. She makes it a point of giving the caregiver a break and takes her mom out for dinner every so often.

Her mother’s situation has not improved but Seligman is learning to cope. By talking about it and seeking help, Seligman’s days are a bit brighter despite living in the shadows of Alzheimer’s.

Walking slows progression of Alzheimer’s

Posted on by System Administrator

I’m still sluggish from all the overindulging I did in the past two weeks.  Because going on a diet is ranked as one of the top 5 New Year’s Resolutions, I thought this study was an appropriate way for us to kick-start 2011.

CHICAGO – Walking may slow cognitive decline in adults with mild cognitive impairment (MCI) and Alzheimer’s disease, as well as in healthy adults, according to a study presented today at the annual meeting of the Radiological Society of North America (RSNA).

“We found that walking five miles per week protects the brain structure over 10 years in people with Alzheimer’s and MCI, especially in areas of the brain’s key memory and learning centers,” said Cyrus Raji, Ph.D., from the Department of Radiology at the University of Pittsburgh in Pennsylvania. “We also found that these people had a slower decline in memory loss over five years.”

Alzheimer’s disease is an irreversible, progressive brain disease that slowly destroys memory and cognitive skills. According to the National Institute on Aging, between 2.4 million and 5.1 million Americans have Alzheimer’s disease. Based on current population trends, that number is expected to increase significantly over the next decade.

In cases of MCI, a person has cognitive or memory problems exceeding typical age-related memory loss, but not yet as severe as those found in Alzheimer’s disease. About half of the people with MCI progress to Alzheimer’s disease.

“Because a cure for Alzheimer’s is not yet a reality, we hope to find ways of alleviating disease progression or symptoms in people who are already cognitively impaired,” Dr. Raji said.

For the ongoing 20-year study, Dr. Raji and colleagues analyzed the relationship between physical activity and brain structure in 426 people, including 299 healthy adults (mean age 78), and 127 cognitively impaired adults (mean age 81), including 83 adults with MCI and 44 adults with Alzheimer’s dementia.

Patients were recruited from the Cardiovascular Health Study. The researchers monitored how far each of the patients walked in a week. After 10 years, all patients underwent 3-D MRI exams to identify changes in brain volume.

“Volume is a vital sign for the brain,” Dr. Raji said. “When it decreases, that means brain cells are dying. But when it remains higher, brain health is being maintained.”

In addition, patients were given the mini-mental state exam (MMSE) to track cognitive decline over five years. Physical activity levels were correlated with MRI and MMSE results. The analysis adjusted for age, gender, body fat composition, head size, education and other factors.

The findings showed across the board that greater amounts of physical activity were associated with greater brain volume. Cognitively impaired people needed to walk at least 58 city blocks, or approximately five miles, per week to maintain brain volume and slow cognitive decline. The healthy adults needed to walk at least 72 city blocks, or six miles, per week to maintain brain volume and significantly reduce their risk for cognitive decline.

Over five years, MMSE scores decreased by an average of five points in cognitively impaired patients who did not engage in a sufficient level of physical activity, compared with a decrease of only one point in patients who met the physical activity requirement.

“Alzheimer’s is a devastating illness, and unfortunately, walking is not a cure,” Dr. Raji said. “But walking can improve your brain’s resistance to the disease and reduce memory loss over time.”

Coauthors are Kirk Erickson, Ph.D., Oscar Lopez, M.D., James Becker, Ph.D., Caterina Rosano, M.D., Anne Newman, M.D., M.P.H., H. Michael Gach, Ph.D., Paul Thompson, Ph.D., April Ho, B.S., and Lewis Kuller, M.D. Note: Copies of RSNA 2010 news releases and electronic images will be available online at RSNA.org/press10 beginning Monday, Nov. 29. RSNA is an association of more than 46,000 radiologists, radiation oncologists, medical physicists and related scientists committed to excellence in patient care through education and research. The Society is based in Oak Brook, Ill. (RSNA.org) Editor’s note: The data in these releases may differ from those in the published abstract and those actually presented at the meeting, as researchers continue to update their data right up until the meeting. To ensure you are using the most up-to-date information, please call the RSNA Newsroom at 1-312-949-3233.

It is the best of times. It is the worst of times.

Posted on by System Administrator

Christmas is not my holiday of religion, but it is my holiday of choice. Over the years, this special day has allowed me to turn vegging into a new art form.  I’ve learned how to ignore dirty dishes and laundry in favour of watching “It’s a Wonderful Life” for the 57th time. Christmas Day is my favourite – there is nothing to do.  No stores to rush to, no office to worry about – just leftover Chinese food eaten from the carton, a stack of DVDs to watch and lots and lots of lolling in bed.  That is until this year.

Now we have the new normal – Mom.  This year Christmas represents stat holidays – so who is going to spend the day with her?  Who is going to manage her day while her wonderful caregivers are spending well-deserved time with their own families?  Who is going to take responsibility?  The answers are obvious but not fun.

Thank goodness I have siblings to share the burden and sadly it has become a burden – because there are no stores to go to, no office as an excuse to not take a turn and my mother doesn’t like Chinese food. An entire day with nothing to do but watch TV or movies is endless when spent with a person who can no longer follow the thread of a plot line, who has no interest in current affairs and doesn’t want to go for a walk because the weather is cold and the sidewalks are slippery.  What used to be a delicious indulgence has become a trying necessity.

And yet, I count my blessings, because as another year slips by, my mother is still here with us.  As the New Year approaches I reflect on how times have changed: I miss her sharp tongue; I miss her stubbornness; I miss the gossip she shared about all sorts of people.  But what I have learned to cherish is her sweetness, her easy smile, her simple outlook on life.

To all my friends and family, best wishes for a Happy New Year.  May it be filled with joy and peace and time spent with loved ones.

Margi Oksner

Bilingualism delays onset of Alzheimer’s symptoms

Posted on by System Administrator

Toronto, Canada – A Canadian science team has found more dramatic evidence that speaking two languages can help delay the onset of Alzheimer’s symptoms by as much as five years.

The latest study, led by Baycrest’s Rotman Research Institute, examined the clinical records of more than 200 patients diagnosed with probable Alzheimer’s disease and found that those who have spoken two or more languages consistently over many years experienced a delay in the onset of their symptoms by as much as 5 years. The study is published in the Nov. 9th issue of Neurology.

The science team includes internationally-renowned cognitive researcher Dr. Fergus Craik of the Rotman Research Institute; Dr. Ellen Bialystok of York University, a leading expert in bilingualism research; and Dr. Morris Freedman, one of Canada’s leading clinicians in the diagnosis and treatment of Alzheimer’s and other dementias.

“We are not claiming that bilingualism in any way prevents Alzheimer’s or other dementias, but it may contribute to cognitive reserve in the brain which appears to delay the onset of Alzheimer’s symptoms for quite some time,” said Dr. Craik, lead investigator and co-editor of The Oxford Handbook of Memory.

The brains of people who speak two languages still show deterioration from Alzheimer’s pathology; however, their special ability with two languages seems to equip them with compensatory skills to hold back the tell-tale symptoms of Alzheimer’s, such as memory loss, confusion, and difficulties with problem-solving and planning.

“These results are especially important for multicultural societies like ours in Canada where bilingualism is common,” said Dr. Bialystok, professor of Psychology at York University and associate scientist at the Rotman Research Institute. “We need to understand how bilingualism changes cognitive ability, especially when there are clinical implications as in this case.”

Observations were made on 211 patients diagnosed with probable Alzheimer’s from the Sam and Ida Ross Memory Clinic at Baycrest, from 2007 to 2009. The patients’ date of diagnosis and age of onset of cognitive impairment were recorded along with information on occupational history, education and language history (i.e. fluency in English and any other languages). Following this procedure, 102 patients were classified as bilingual and 109 as monolingual.

The researchers found that bilingual patients had been diagnosed with Alzheimer’s 4.3 years later and had reported the onset of symptoms five years later than the monolingual patients. The groups were equivalent on measures of cognitive and occupational level, there was no apparent effect of immigration status, and there were no gender differences.

http://www.youtube.com/v/LLMv720oh7E?fs=1&hl=en_US&color1=0x2b405b&color2=0x6b8ab6

The Neurology paper replicates findings from the team’s widely-reported 2007 study led by Dr. Bialystok and published in Neuropsychologia. That study examined the clinical records of 184 patients diagnosed with probable Alzheimer’s and other forms of dementia – and found that bilingual patients delayed the onset of their symptoms by four years compared to monolingual patients.

The current study adds to mounting scientific evidence that lifestyle factors – such as regular cardiovascular exercise, a healthy diet, and speaking more than one language – can play a central role in how the brain copes with age-related cognitive decline and diseases such as Alzheimer’s.

“Although a great deal of research is being focused on the development of new and more effective medications for Alzheimer’s disease, there are currently no drug treatments that show any effects on delaying Alzheimer’s symptoms, let alone delaying the onset of these symptoms by up to five years,” said Dr. Freedman, head of Neurology and director of the Sam and Ida Ross Memory Clinic at Baycrest.

This study was supported by the Canadian Institutes of Health Research and the Alzheimer Society of Canada

reprinted from Smart Aging – Powered by Baycrest Innovation and Research, December 2010/January 2011 edition

B17 – BINGO

Posted on by System Administrator

On Mondays and Wednesdays my mother Frida comes to Baycrest for the adult day care program.  I like to visit her on those days because a) I get to see her and b) she loves it when I come to visit her among her cronies.  It makes her feel very special and I must say, it makes me happy to see her happy.

Monday was a good day. When I arrived she had just started playing Bingo. I stood by, not wanting to interrupt the game and noticed that she had absolutely no problem playing.  Whatever number the caller shouted out that was on her card, my mother immediately identified.  She had full grasp of the concept, the game and the numbers.  It was a good day.

Last week, on my post-lunch visit, I arrived just as her little cadre of friends had begun to play Rummikub – a tile version of the card game gin rummy.

My mom has been playing gin rummy, rummy and rummikub in various forms for as long as I can remember.  Growing up, Wednesday night was my mom’s ladies card night – she was one of eight in a group who played weekly, rotating from home to home.  The Wednesday it was at our house, was always filled with excitement –  there were all kinds of goodies – fresh baked desserts, bridge mix in bowls, luscious fruit – and none of it was to be touched – it was for the company.  We children were paraded out to say hello and be nice to the ladies and then off to bed, listening to the shuffling of cards and chatter of good female friends.

By the time I had children of my own, my mother was teaching them to play cards and rummikub at her kitchen table.  Her style and methodology was the same with each child, carefully teaching them about the different suites and explaining how important it was to put the cards in order first by suite and then numerically.  She was very organized and strategic.  The skill and finesse came later.

So back to last week, on my post-lunch visit and her Rummikub game.  There was a lady helping Frida – because she could not organize her tiles – theywere in random order, all four suites mixed together. At first I thought she had a strategy in mind to create a winning hand, but the more I studied her hand, the more I watched her arrange and rearrange her tiles, the more it became evident that she was having difficulty sorting out the tiles and making sense of what was going on around her.

The saddest part was that she was fully cognizant that there was a problem.  She was allowing a helper to work with her; she didn’t exhibit any signs of frustration; she just sighed, resigning herself to this newest state of confusion.  I apologized for interrupting her concentration – and that I would let her get back to her game – I tried to shoulder the responsibility for this new ‘wrinkle’, I tried to make her feel better about herself.  It was not a good day for either of us.

Margi Oksner

Let Me Introduce Dr. Norman Farb

Posted on by System Administrator

On September 1, 2010 Dr. Norman Farb joined the staff at Baycrest as the Women of Baycrest postdoctoral fellow working with Dr. Tiffany Chow in the Frontotemporal Dementia Workgroup.  Norman is dedicated to advancing both public understanding of the disorder and developing new techniques for the assessment and care of patients with dementia.  The other area of Norman’s work is related to caregivers, who are also critically affected by Frontotemporal Dementia and related disorders.

The other evening, Dr. Farb was the guest speaker at the Women of Baycrest annual Membership Appreciation Reception and Dedication.  He spoke about the work he is doing to develop a new model of care to improve quality of life in aging.  Here’s some of what we learned from Dr. Norman Farb.

The Canadian Study of Health and Aging estimates that in 2011 there will be 145,000 new cases of dementia in Canada, of which approximately 93,000 will be women.  This is not simply a problem for the elderly, but one with broader social implications, as we will all be affected by the need to provide additional care for our elderly,

Worldwide, the elderly support ratio – that is the ratio between working-age people under the age of 65 and those 65 and older stands a 9 working age people to 1 elder, but this ratio will fall to 4:1 in the next 40 years.  In Canada the ratio is 5:1 right now, and by 2050 it will be closer to 2:1.  What this means is that many of us will have a parent, or relative in need of care in the coming years, with a proportionally smaller workforce to provide this care.

While increased healthcare spending is one way to provide this extra support, realistically, the biggest adjustments will need to be made by family members.  The question is not IF you will become a caregiver in your lifetime, it’s a matter of WHEN.  Familial caregiving is important and it makes a difference: the absence of a caregiver or having a caregiver who feels overburdened are both major predictors of earlier institutionalization of those with dementia.

Women have particular challenges in caregiving; social factors make women more likely to take on the caregiving role and be more heavily involved in caregiving activities than men.  In Canada over 70% of informal caregivers are women, mostly wives, daughters and daughters-in-law.  What’s more, 30% of these female informal caregivers are employed, and may also be providing care to their own families at the same time; this places increased stresses on women that are greater than what is experienced by male caregivers.  A recent study found that female caregivers had lower scores on 7 out of the 8 scales on a Quality of Life Questionnaire compared to males and an overall decreased quality of life, as a result of more emotional and physical health problems.  One major question that we face as a society in coming years, above and beyond how to care for our aging population is: who cares for the caregivers?

Norman is currently researching a new type of training for caregivers known as mindfulness training.  Derived from eastern meditation practices, mindfulness training helps a person to develop the capacity to directly experience each moment with a sense of acceptance, opening themselves up to immediate experience rather than turning to a world of judgments, explanations and rumination.  In many studies in healthy participants, mindfulness training has been shown to reduce feelings of stress and to promote well-being, and it may also help to protect caregivers from becoming overburdened and sick themselves.

It seems from the research that what the mindfulness training is allowing people to do is to stop worrying about the bigger picture for a moment and to concentrate on what’s actually happening in the room they are in.  In the context of caring for an ill or demented family member, this can be a powerful ability.  Imagine yourself in the role of caregiver for an elder relative, how would you react?  For many of us, there are negative feelings, like we are being forced into a bad situation.  But why is this?  Could it be that we are all secretly hoping that life will continue happily ever after?  Isn’t that the way that fairy tales end?  Cinderella does not end up cleaning bed pans.

There is nothing wrong with having ideals and dreams of a pleasant future.  These ideals become a benchmark by which to motivate ourselves to do and be more.  However, dreams alone do not prepare us to deal with the reality of our aging population and probable roles.  To effectively manage the stresses of familial caregiving, a deeper understanding must be cultivated.  Dr. Norman Farb believes that learning to put our evaluations and ideals aside and accept our present state is a powerful tool for reducing the stresses of confronting a life more ordinary than fairy tale, of allowing us to appreciate the gift of each moment even if that moment is being spent looking after mom or dad.

Margi Oksner

Remembrance Day

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Yesterday was filled with poignant pauses.  At 11:00 am we observed two minutes of silence to honour those who sacrificed their lives in the name of freedom.

All day, the radio waves were filled with amazing testimonials from survivors of WWII, Korea, Viet Nam and now Afghanistan.  Their stories of comrades lost and bonds of friendship that have endured for 70 years; the sadness to hear that this was the first year without a single World War I veteran present in Ottawa at the national wreath laying.

It was a day of remembrance.

And what of those who can no long remember.  Does my mother remember the family she lost in World War II, the DP camp where she met my father, the year spent in Cyprus because of the British blockade of Israel, the years in Israel while her husband fought in yet another war for independence and then the immigration to Canada – her home for the last 62 years.

My mother has become a veteran of life.  She has survived for 87 years but the last year has been filled with more losses than gains.  What did Remembrance Day mean to her.  My guess – it did not register on any radar screen in her mind.  It will now be our collective role as her children and grandchildren to remember for her.

Margi Oksner