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Technorati Tags: Alzheimer's,AD,Dementia,C-Span,Seth Rogen,Senate,Epidemic,Seniors

Wednesday, October 23, 2013

Harvard: Chocolate Protects Against Alzheimer’s

Dark Chocolate and Cocoa

NewsMaxHealth.com: Here's some sweet health news for chocolate lovers: A daily dose of the sugary treat may help prevent Alzheimer's disease. That's the conclusion of new research at Harvard Medical School that found people who drank two cups of hot cocoa a day had improved memory and blood flow to the brain.

But the benefits only come from certain types of chocolate, which contain high levels of beneficial antioxidants, notes one of the nation's top Alzheimer's experts, Dr. Gary Small, professor of psychiatry and aging. It's also important to know that you can get too much of a good thing.

"I think it is healthy in moderation, that's the key because if you drink too much cocoa or eat too many chocolate bars you’re going to gain a lot of calories and that is not good for the brain," Dr. Small tells Newsmax Health. "In fact it's the dark chocolates that are particularly potent; milk chocolates have very little and white chocolate has almost none. So if you want the antioxidant boost, go for the dark chocolate."

Scientific research has found dark chocolates — and a host of other foods — contain powerful antioxidant flavonoids that are good for the brain, explains Dr. Small, director of the University of California-Los Angeles Longevity Center.

"As the brain ages, it undergoes wear and tear in what's called oxidative stress," he notes. "And these antioxidants in our foods actually protect the brain from that kind of aging wear and tear."

The latest Harvard study, published in a recent issue of the journal Neurology, found cocoa consumption boosts thinking and memory performance, as well as something called "neurovascular coupling" — where blood flow in the brain changes in response to brain activity — which plays a key role in Alzheimer’s and other mental-health conditions.

For the study, investigators recruited 60 seniors and asked them to drink two cups of hot cocoa a day for a month. Half drank cocoa high in antioxidants, while the others drank cocoa that had lower levels of the beneficial compounds.

At the end of the study, the team tested the participants' memory and thinking skills, and used ultrasound to measure neurovascular coupling in their brains as they completed mental tests. The results showed 18 of the 60 participants had impaired neurovascular coupling problems at the start of the study, but after drinking the high-potency coco, it had improved by 8.3 percent. They also scored better on memory tests.

Dr. Small notes that chocolate isn't the only source of antioxidants. Many vegetables and fruits — including strawberries, blueberries, broccoli, spinach, and other green leafy vegetables — are packed with the beneficial compounds.

"So there are many ways to get antioxidants in your diet and it’s a great idea to get more and more servings of fruits and vegetables," he says. "Most Americans don’t get enough."

At the same time, he also recommends cutting down on foods that have been shown to contribute to mental declines, including *milk and dairy products, **processed foods, and snacks loaded with refined sugar — such as chips, crackers, and pastries.

"It's okay to have them a little bit, but when we overdo it it's certainly not good for our brains and it's not good for our bodies," Dr. Small says.

Story continues here with Dr. Small on Video

*The human body loses the capacity to metabolize milk and dairy products beginning at age 3 and completely by age 17, so consuming milk and dairy does not help help with your calcium intake because our bodies no longer break it down into a form that our bodies can use. So for many people it only adds weight and gives them digestion problems because they are lactose intolerant.

**Butter on the other hand, should really be considered more of a fat than a dairy product and should be the choice over margarine, a completely synthetic product. Margarine is only one molecule away from plastic and many doctors feel it could be a contributor to many diseases and conditions, including AD.

***The list of processed foods is long but products made with artificial sweeteners, GMO foods, preservatives and flavor enhancers that you can’t pronounce, etc. should be avoided.

1 in 3 Seniors Dies with Alzheimer's or Other Dementia

When You Say ‘Enough’ To Giving In Home Care

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Part One: Researchers race to beat scourge of aging

Part Three: Burden of illness often heaviest for caregivers

UCLA on Alzheimer's Disease - young or old should read

Super Spice Secrets: Can This Miracle Spice Stop Cancer, Alzheimer's and Arthritis?

Stop Using 'Natural' Deodorants Until You Read This

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Pet Therapy

Animals Helping the Ailing, the Elderly, and the Young

Buttered Popcorn Flavoring Linked to Alzheimer’s

7 Alzheimer's Triggers by Dr. Blaylock – definitely worth listening to!!

Find Dementia Care

Games for Alzheimer's

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Books

The Healing Powers of Chocolate (Kindle)

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The Alzheimer's Prevention Program: Keep Your Brain Healthy for the Rest of Your Life

Technorati Tags: antioxidants,flavonoids,aging,Seniors,chocolate,Alzheimer's,AD,Dementia,studies,memory,Harvard,longevity,UCLA,strawberries,blueberries,broccoli,spinach,leafy green vegetables,healthy food choices,dark chocolate,NewsMax,hot cocoa,caregivers

Tuesday, July 2, 2013

When You Say ‘Enough’ To Giving In Home Care

How to make the decision to end the ‘in your home care’ of an elder. by francy Dickinson

Toots w Kathy, Merrilee n Francy at mother’s downstairs area in our home

Dear Francy: I don’t know what to do…I am in trouble and too tired to make a decision. My husband has MS and he is still functioning on his own. He is in a wheelchair but he has a good life at home, as a writer. We have three children ages 10-15 years and they are in the swirl of life. I have been a part-time cook at the local cafe. My husband’s aunt is all alone in the world and very dear to us. We have a mother-in-law outbuilding in our backyard and we have fixed it up and moved the Auntie in, to be close to us. She is a quiet and kind person that was doing for herself but she needed a lot of our help. It all seemed great for the first three months she was here. Then she got the flu and complications and she became more frail. Now, I have to care for her…running back and forth over the path to what the kids call “the cottage”. I am getting so tired and the house is beginning to feel the pressures. I don’t know what to do. Our Aunt has done nothing to upset us…she is just getting older and needs more care. Do you think this is just a bump? Or is this going to spiral down and take more of my time?

I can not tell you that, I am not a professional medical person. I am just a person that has years of giving in home care to my family and elders. So, what I will do is write down a list of things to help care givers with ‘in home care’ situations and you can pick and choose what might help you. Just remember there is no guilt when you try to give help and love to another…life changes and things often have to change. You are really in a situation that many others are…you are sandwiched in between job and family vs the care of a senior. Just the kindness of your heart, to make room for your beloved Aunt, is very dear to me. Thank you.

IDEAS OF HOW TO DECIDE, WHEN TO GIVE ELDER CARE IN YOUR HOME:

YOU have to save yourself first! My dear friend Cheryl, was a flight attendant for 25 years and they were taught to be the first to grab the oxygen when it dropped down! So they could stay clear headed and help others. Its a lesson for all of us to remember when we face situations that require so much of us as care givers.
START SMALL. If you just take time to sit with your spouse and go over the needs list for your aunt and decide who will do what. Do not forget your children, they are all old enough to do little things and be in charge of this or that. Maybe they will take over more of the “in your house or yard chores” so you can go and take care of your Auntie. Be honest…this time can be an amazing learning lesson for your children and you. Giving up some of your own wants and doing for others…is what characters are built on. But this organization meeting will show you how much time you are spending. I don’t want to be out of place saying this…but a business meeting is like a “Come to Jesus”. You finally see what is in front of you.
ASKING FOR HELP: If your Auntie has money then you have to be honest with her and get her to allow you to hire help. It could be a cleaning lady for both places that allows you to forget the little things a bit. The one help I insist on is a bath lady. I have said this a million times. They are worth their weight in gold and they should be the first on a sparse budget. They will take that pressure away and get the bath and hair all clean in a ‘faster than light’ action. Plus, they are another friendly face for the senior. NO MONEY? Then you simply have to go down to the social services and get your Aunt signed up. They will do a review of her income and your care giving and they will provide help to make it easier for you. They will pay for her medications, they will provide food stamps for her food, they will pay – you – for care you are giving. (they do not pay for a spouse but they will pay for a family member or friend) Yes, in return they will make demands. You have to keep a clean area for the senior and do a few hours of nursing classes to teach you how to give healthy and wise care. But it was a life saver for me when mother’s care went into overdrive and I was not able to work any longer.
BE HONEST: If you pretend life is fine, you are signing your own health decline order. This is not easy stuff…you simply have to say…I NEED REST. You can ask other family members to come one day a week, so you can ease your strain or simply sleep. You can ask your employer if you could just work two days instead of four days. Your income from the state should cover this change. You will find an increase in your expenses. Seniors require expensive food, protein drinks, Depends, extra electric bills with the increased clothes washing and heat bills. (seniors need heat all year round) Talk, the more you talk and ask for help…the more your family and community services will hear you and add you to their listing.
COMMUNITY SERVICES AND FAITH BASED HELP: Even if you do not belong to a faith group, your local church, temple, etc is there for you. You are a part of their extended community and they will reach out to you. You may find that they have a list of retirees that are willing to come and just visit or sit with your senior so you can leave the house and shop. Or the senior can get a good laugh with a person of their own generation. You may find they have a food bank to help with extra items, they also have visiting lay-ministry people that will come and just talk with the senior. Do not get uppity about community help. Those services are made up of others that have gone through what you are going through and decided to put a group together to help others. Take advantage of their ideas and service time available.
RELEASE ANGER: I have a list of families that are angry with their relatives because they did not help with giving care to their elder. If you can ask family to help you…to come and visit when you need to be at school for the kids…or to buy your elder a pair of slippers or new housecoat…then do it. But if they don’t…let it go. Just do not spend your already low energy on anyone that is not willing to reach out and give you a hug and help in your time of high stress. Those folks are not worth it. Let it be…
GET A POWER OF ATTORNEY AND HEALTH CARE DIRECTIVE: I am afraid I often say this, so if you read my blog…its a repeat. But there is nothing, and I mean nothing more frustrating — than to give care to an elder on a daily basis and then have some punk realitive walk in the door and tell you that another anxiety medication is not really needed for your elder. Like they know! No one knows more than the “in home care giver” so you need to insist that you can make the decisions on the behalf of the elder. Then it will be your moral duty to make them in the best way you can, for the elder. Trust me, each time I talk about this…people think…OH my sister is better with forms and she will do it. NOT
GATHER A HEALTH TEAM: Add your senior’s family doctor, get a specialist to at least see the elder once and review things. Get a nurse to talk to or just get a nurse practitioner to be your main care giver reference. Now lets talk real. Doctors diagnose they do not treat you. A nurse or care giver treats. So you need to learn how to ask the doctor questions and understand the chemistry of the elder’s health problems. The better your questions are, the easier the care giving will be. Then you need to know what will happen at home…and what that means you will be doing about the care. If you go through a bump, ask the doctor for in home nurse care, he can order that and the nurse will show you how to treat the elder. Bring in a nurse contact or help line to help you decide how to care for the elder at home and a pharmacist to explain the medications needed. The doctor will give you drugs and what is called an Rx for things like physical therapy, wheelchairs, in home help of an occupational therapist, message, therapy sessions, supplements etc. This is important; anything your senior needs should be written as a prescription so the insurance and medicare will accept it and help pay for it. Always ask the doctor to prescribe something and to give you generic medications so you are not going down a big hole when free services and medications are available to you.
YES> THIS MEANS YOU NEED TO BE ORGANIZED. So don’t be a baby…the more you write down, the more questions you ask, the more you get clarified…the easier the care giving will be.
Remember; talk to a nurse about home care tips…read my blog and learn home care tips. Use the Internet for extra advise and read it all…then make your own decisions. Talk about supplements that will help the elder and special ways to use food and exercise to increase the abilities of any senior in any stage of decline. Understand bowel movement difficulty, side effects of medications, dizziness, avoiding falls, eating difficulties, hydration challenges. All these things will come up so you need to write them down and have doctor or nurse show you how to treat the problems at home. It is not scary if you understand and are prepared.
NO< NO< NO: I just do not want to clean a bottom, or smell blood, give a shot, or lift the elder up out of a chair. OK…see, that is being honest with who you are. It does not make you a bad person. You need to draw a line in the sand and when you come to that line the elder is going to be placed in a care facility. Everyone has a line, yours maybe closer than mine…but that does not make me a better person. I have a disposition to give care. I never knew I did…I was never a girl that said I wanted to be Nurse Francy. Now I know, that I can turn off my mind and just give the care without getting sick or too involved in the immediate yucky situation. Some can, some cannot. Know yourself and draw your line. I have a line. I drew it with my mother and now it is firmly in place with my husband and his decline with Alzheimer’s. They have to walk or at least be transferable. I have a very bad back and I simply can not lift a huge person and walk around without a great deal of pain. What is your line in the sand?
HAVE A PLAN: Is there respite services you can use or senior day care services? Ask and find out how the local community is prepared to help you with rest. There needs to be a plan, where would you take your elder if they need to leave you? Some where close so you can visit and keep an eye on their care. Have the place in your mind. Go and visit, tell them what you are doing and ask if they take medicare patients, if they have a long waiting list, if you could be on a secondary list of placement in case of emergency, etc. Once this is done, you will then be able to relax and know a quick transfer to a facility will not end up in you moving the senior again because the facility was not up to your standards of care. Call Hospice and ask them when you are to use their services…ask them how to judge the situation and they will walk you through a review of how to use them. So, if the senior is sinking down and wants to die at home…you can get help. Hospice also has facilities for end of life care…so find out the best way to use their services, now. Lastly, know what would happen if your elder passed in their sleep. Who do you call, is there money for a funeral, do they want a funeral. Do they want to be buried or cremated? Get it done early in the time you take the elder into your house. So as care accelerates you do not have to add another layer of upset to your own life. Get all this over and done. Then you can turn your attention to today…and making it a day of joy for you and your senior.

You may think no one cares about you being tired, upset and stressed over senior care. You may think that no one has ever been where you are today…but you are wrong. Generations have faced the same problems and found solutions that worked for them. One step at a time…give it time. A senior may have a big dip… and then in a week or two they will regroup, re energize and come back up in strength and life will go on again. Give it all time. You take time to get over the flu…a senior takes more time. But encourage them to get well… keep them moving, drinking, eating and laughing. Let them know you want them to live… to the end of their life. Not just make it through to end. Keep your heart in the race and it will work out. Care giving is just a short part of your life time. The gift of your giving your heart… will come back to you in so many rich ways… year after year.

Blessings on all that you do for your family and your dear elder.

francy

1 in 3 Seniors Dies with Alzheimer's or Other Dementia

UCLA on Alzheimer's Disease - young or old should read

Diagnosis & Treatment of Mild to Moderate Alzheimer's Disease

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Alzheimer’s Disease and Inappropriate Sexual Behavior

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Part Three: Burden of illness often heaviest for caregivers

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Technorati Tags: Care Givers,Caregivers,Caretakers,Alzheimer's,Dementia,AD,Seniors,aging,in-home care,Choices,Eldercare,elderly,Special Needs Patients,Autism

Sunday, May 26, 2013

Alzheimer's: Tips to make holidays more enjoyable

Holidays can be bittersweet for families affected by Alzheimer's. Try these simple tips to make the holidays less disruptive and more pleasant for everyone.

By Mayo Clinic staff

If you're like many who are caring for a loved one with dementia, the holiday season may not feel so merry. Memories of better times may surface as reminders of what you've lost or what has changed. At a time when you believe you should be happy, you may instead find that stress, disappointment and sadness prevail.

At the same time, you may think that you should live up to expectations of family traditions and how things ought to be. As a caregiver, it isn't realistic to think that you will have the time or the energy to participate in all of the holiday activities as you once did.

Yet, by adjusting your expectations and modifying some traditions, you can still find meaning and joy for you and your family. Here are some ideas.

Keep it simple at home

If you're caring for a loved one who has Alzheimer's at home:

Make preparations together. If you bake, your loved one may be able to participate by measuring flour, stirring batter or rolling dough. You may find it meaningful to open holiday cards or wrap gifts together. Remember to concentrate on the process, rather than the result.
Tone down your decorations. Blinking lights and large decorative displays can cause disorientation. Avoid lighted candles and other safety hazards, as well as decorations that could be mistaken for edible treats — such as artificial fruits.
Host quiet, slow-paced gatherings. Music, conversation and meal preparation all add to the noise and stimulation of an event. Yet for a person who has Alzheimer's, a calm and quiet environment usually is best. Keep daily routines in place as much as possible and, as needed, provide your loved one a place to rest during family get-togethers.

Be practical away from home

If your loved one lives in a nursing home or other facility:

Celebrate in the most familiar setting. For many people who have Alzheimer's, a change of environment — even a visit home — can cause anxiety. Instead of creating that disruption, consider holding a small family celebration at the facility. You might also participate in holiday activities planned for the residents.
Minimize visitor traffic. Arrange for a few family members to drop in on different days. Even if your loved one isn't sure who's who, two or three familiar faces are likely to be welcome, while nine or 10 people may be overwhelming.
Schedule visits at your loved one's best time of day. People who have Alzheimer's tire easily, especially as the disease progresses. Your loved one may appreciate morning and lunchtime visitors more than those in the afternoon or evening.

Care for yourself

Consider your needs, as well as those of your loved one. To manage your expectations of yourself:

Pick and choose. Decide which holiday activities and traditions are most important, and focus on those you enjoy. Remember that you can't do it all.
Simplify. Bake fewer cookies. Buy fewer gifts. Don't feel pressured to display all of your holiday decorations or include a handwritten note with each holiday card. Ask others to provide portions of holiday meals.
Delegate. Remember family members and friends who've offered their assistance. Let them help with cleaning, addressing cards and shopping for gifts. Ask if one of your children or a close friend could stay with your loved one while you go to a holiday party.

Trust your instincts

As a caregiver, you know your loved one's abilities best. You also know what's most likely to agitate or upset your loved one. Resist pressure to celebrate the way others may expect you to. Remember, you can't control the progress of Alzheimer's or protect your loved one from all distress — but by planning and setting firm boundaries, you can avoid needless holiday stress and enjoy the warmth of the season.

Part One: Researchers race to beat scourge of aging

Part Three: Burden of illness often heaviest for caregivers

Diagnosis & Treatment of Mild to Moderate Alzheimer's Disease

UCLA on Alzheimer's Disease - young or old should read

Super Spice Secrets: Can This Miracle Spice Stop Cancer, Alzheimer's and Arthritis?

Stop Using 'Natural' Deodorants Until You Read This

Alzheimer’s Disease and Inappropriate Sexual Behavior

Pet Therapy

Animals Helping the Ailing, the Elderly, and the Young

Buttered Popcorn Flavoring Linked to Alzheimer’s

7 Alzheimer's Triggers by Dr. Blaylock – definitely worth listening to!!

Find Dementia Care

Games for Alzheimer's

Alzheimer's Homes

Stop Using 'Natural' Deodorants Until You Read This

Super Spice Secrets: Can This Miracle Spice Stop Cancer, Alzheimer's and Arthritis?

Alzheimer's patients follow different paths to a final debilitation

Wednesday, April 10, 2013

Alzheimer's patients follow different paths to a final debilitation

Untangling Alzheimer's – Part 2 of 3

Post-Gazette.com: Sitting in a small office on the fourth floor of UPMC Montefiore, Mary Lewellyn eagerly awaits a question from someone trying to assess her weakened mind's abilities.

Mary Lewellyn, 59, of Robinson has the "early-onset" version of Alzheimer's. (Andy Starnes, Post-Gazette)

"Do you know what day it is?" she is asked, a standard test question for Alzheimer's patients.

Lewellyn had come in from outside just minutes earlier, on a glorious October afternoon with the sun shining and the temperature reaching 70 degrees. She smiles beneath her frizzy hair, leaning forward in an earnest attempt to answer this once-simple question.

"December thirty-three -- is that what it is?" she responds, bright-eyed.

Eight years ago, Mary Lewellyn worked as a bookkeeper, helped her husband renovate their Robinson home and dreamed of retiring with him someday to Colorado Springs.

10 warning signs of Alzheimer's

1. Memory loss that affects job skills.
2. Difficulty performing familiar tasks.
3. Problems with language.
4. Disorientation to time and place.
5. Poor or decreased judgment.
6. Problems with abstract thinking.
7. Misplacing things.
8. Changes in mood or behavior.
9. Changes in personality.
10. Loss of initiative.

Four years ago, she could no longer compute numbers easily and was forgetting normal household chores. A neurologist suspected she was in the early stages of Alzheimer's disease.

By the time of her recent evaluation, at the Memory Disorders Clinic of the University of Pittsburgh's Alzheimer Disease Research Center, the 59-year-old woman could no longer tell the time of year or what city she was in. Her ability to add two numbers or write a coherent sentence had vanished, just like her job, her retirement plans and her role as equal spouse to Jim Lewellyn, her husband for 18 years.

Jim, patient and mild-mannered, told clinic coordinator Lori Smith Macedonia at the end of Mary's test of mental functioning that she seemed healthy as could be in some ways -- dancing at a wedding, roller-skating with relatives, singing songs from "Oklahoma" loudly in good pitch as he played them on a Hammond organ at home.

Mary scored but 8 out of 30 points, however, on the 30-minute Mini-Mental State Examination, a key tool to monitor dementia patients' ability to think, memorize and follow instructions. She had correctly answered twice as many questions a year earlier. That explains why Jim has to tend to most of her needs, from helping her dress to preparing her meals.

"A lot of people seriously impaired have very good physical states," Macedonia, a physician's assistant, explained afterward. "She could get up and run a race but she is very severely impaired."

Macedonia and Jim agreed to increase Mary's dosage of Exelon, a new drug intended to help preserve cognition, but there was no certainty it would help. The three drugs approved specifically for treatment of Alzheimer's sometimes help treat symptoms and sometimes don't. They are far from a cure even for the patients who respond best.

The Lewellyns will continue periodic visits to the memory clinic, but they hold no illusions it will free Mary of the disease.

Deciphering the signs

The first sign of Alzheimer's can be imperceptible.

Forgetting a name, misplacing car keys or unintentionally missing an appointment happens to most people from time to time, especially as they age. It doesn't mean they're diseased.

The time to be concerned is when short-term memory problems occur frequently. If a family member recognizes a pattern of forgetfulness in a parent or spouse, a medical evaluation may be in order if the person hasn't volunteered for one.

In Mary Lewellyn's case, Jim realizes now, the first signal was when he was working in the back yard on hot days, and Mary would offer to get him a drink. She'd go into the house, and he wouldn't see her again for hours as she busied herself with other tasks, forgetting about him sweating outside.

"I wasn't being mean," she says now, with a laugh, though she'd give anything to relive those days when she could accomplish menial chores.

For some people, the first difficulty they notice is disorientation while driving. Others with a lifelong hobby requiring concentration, such as bridge, can no longer grasp the key details. Husbands telegraph the problem by repeatedly forgetting to mow the lawn, and wives lose track of where they parked the car while shopping.

Donald Helton remembers the day in 1993 his grandmother left the stove on unattended in their Elizabeth Township home, a wake-up call that she had a problem requiring attention in order to avert a disaster such as the house burning down.

"Oh, boy, wouldn't that be awful," 86-year-old Mary Gonzales says while listening now, as though her grandson were talking about some other person. "God forbid."

Short-term memory is the first casualty of Alzheimer's, but it takes more than memory loss to be diagnosed with the disease. Someone with that difficulty alone is usually considered to have mild cognitive impairment, which is often but not always a sign that Alzheimer's is ahead.

By the time they are diagnosed with Alzheimer's, individuals typically will have also lost some reasoning ability or language skills or undergone changes in behavior, such as apathy or agitation. That's often several years after the appearance of the memory problems, which may take on significance only in retrospect.

People with early Alzheimer's often hide it, even from themselves, by sticking to a familiar routine and avoiding new, uncertain situations. They and relatives laugh off some of the potential warning signs and attribute them to age rather than disease, a form of denial thought to be more common among men than women.

Jim and Mary Lewellyn can still enjoy musical evenings at home. (Andy Starnes, Post-Gazette)

"There is more undetected Alzheimer's than you would imagine" said Dr. James T. Becker, a University of Pittsburgh neuropsychologist. "Some of that may still be related to the way we think about the elderly. Part of that is from how people earlier in the disease adapt. You very quietly change your lifestyle, and even your family may not notice."

Diagnosing the disease

I.G., an 80-year-old woman visiting the Memory Disorders Clinic, is able to spell, count and draw without hesitation but is stumped by the most telling part of the exam: a request that she recall three words given to her several minutes earlier.

"Heh, heh, you're kidding," she says with a chuckle. "I forget what they were. I forget very easily. ... Was 'table' one?"

Yes, it was. So were "apple" and "penny," words that evaporated quickly in a mind clogged by the mild-to-moderate stage of Alzheimer's.

By the time she is asked to write a complete sentence, the very dignified I.G., who did not want to be identified publicly, acts put off by this process of assessing her mental functioning. She writes clearly: "I think it's about time to go home."

The first medical visit where Alzheimer's is discussed can be deadly uncomfortable.

If it is in the office of an Alzheimer's specialist, usually the patient himself is the last one who wants to be there, noted Dr. Michael Usman, who operates the private, non-profit Alzheimer Center of Pittsburgh in Robinson. It's one disease with an ironic twist -- the fact that you have it makes you among the least likely to recognize it.

"Usually, if I ask flat-out, 'Why are you here?' the response is 'Because she brought me,'" Usman said, pointing to where a patient's daughter would sit in his office.

Specialists such as Usman say they may spend four hours on an initial examination in order to determine whether Alzheimer's is present. A team approach is used in which the patient may get physical, neurological and psychiatric or psychological evaluations, as well as interviews done by a social worker with the patient and family members. Sometimes, a brain imaging scan is ordered to rule out stroke or other illnesses that could be affecting the mind.

Such full-court scrutiny can diagnose Alzheimer's with 90 percent or more accuracy, but absolute certainty can only be provided by a brain autopsy. Because it's so dreaded a disease, it's essential that physicians avoid bludgeoning people with references to it and instead focus on helping them, said Richard Besdine, director of the Brown University Center for Gerontology and Health Care Research.

"With mention of the word Alzheimer's, the listening capacity [of patients and relatives] falls off dramatically," Besdine said.

Most people with Alzheimer's and other dementia are cared for by their own physicians, which can pose a problem in the managed-care world. Doctors are reimbursed better for brief stints of hands-on medical treatment than the more leisurely conversation and assessments necessary to manage a person's dementia by monitoring medications and advising caregivers.

Alzheimer's specialists routinely gripe that primary care physicians don't diagnose dementia quickly enough, which could be a carryover from days when treatment options were unavailable to them and a diagnosis mattered little. Now the drugs Aricept and Exelon can delay effects of the disease for up to a year in some patients.

Doctors say the population is becoming better educated every year about the disease and the possibility of getting help for it. New patients at Pitt's Alzheimer Disease Research Center are more commonly arriving within a couple of years after symptoms first appear, when it used to take four or five years, said neurologist Dr. Daniel Kaufer.

Sometimes, he can tell families that the patient has only mild cognitive impairment, a relief to them, but one followed by the warning that half of the people in that state are likely to have Alzheimer's within five years.

Less than 20 percent of the time, the extensive team examination determines the dementia of a loved one is caused by a disease other than Alzheimer's. Kaufer said that news can be even worse for families than a diagnosis of Alzheimer's, because less progress has been made in researching vascular, frontotemporal and other dementias. And often, one of those other dementias overlaps with Alzheimer's.

A different path for everyone

The Alzheimer's course can run as long as 20 years from the first symptoms until death, though it's more typically half that. It's usually a shorter, swifter decline for the fewer than 10 percent who, like Mary Lewellyn, get the "early-onset" version of the disease between their 40s and early 60s.

Each person's experience with the disease is different. Each patient carries a different level of awareness of what is taking place inside their troubled brain. Some know they have Alzheimer's, some just know things seem different from before, and some are clueless that there's anything wrong.

Their lack of insight and loss of language skills make it hard for the victims to discuss the disease, even when they know they're being affected.

"It was gradual," Mary Lewellyn says on her home's back deck one day, quietly deferring to her husband until she is asked point blank how she has been affected. "I don't know, really. ... Something happened -- I have no clue."

At a support group of the local Alzheimer's Association, individuals in the early stages of the disease are better able to discuss the turmoil in their heads and lives. Each month, they share insecurities about strange situations, mishaps at home and hardships they create for relatives.

"I don't think anybody can understand what you're going through. It's like somebody dropped a bomb on you, and it blew up," Phyllis Herrup, 71, of McKeesport, said at one meeting as some of the seven other heads around the table nodded.

One day, her husband found her taking apart pieces of the washing machine. She didn't know why. Her memory's been slipping since 1994, and it's a source of daily frustration for the college graduate who has served on McKeesport's school board and development authority.

"If I put down a book or magazine and then look for it, I can't find it," she said. "It just drives me up the wall."

Irene Vellella of Bellevue, who also attends the support group, doesn't see herself as handicapped. Diagnosed with Alzheimer's a year ago, the 77-year-old woman still lives in her own apartment but has given up driving and control of her financial affairs to her children. She says those decisions weren't necessary but make life easier for her, and she faults the memories of friends and relatives as much or more than her own.

"[Patients] often don't understand what's happening, even at the early stage," said Dr. Amelia Gennari, the UPMC Shadyside geriatrician who diagnosed Vellella and encouraged her to give her checkbook to her son. Doctors often take on the "bad guy" role for families and deliver tough advice to patients in denial of their shortcomings.

"The biggest problem often in the early stage is depression, and fortunately, we do have good treatment for that," Gennari said.

About one-fourth of Alzheimer's patients suffer depression, studies suggest. At least that many have delusions or paranoia, and twice as many become easily agitated. Managing Alzheimer's long term often involves treating such personality difficulties with specific drugs and with advice to caregivers, just as much as addressing the patient's loss of memory and reasoning.

A final, debilitating decline

The physician's assistant testing Mary Gonzales' abilities at the Memory Disorders Clinic taps the wrinkled woman's knee, soliciting her attention.

"Mary, what year is it?"

"Oh, 19-about-53 or something, I don't know," the 86-year-old woman responds. "I usually know, but I've had all these things on my mind."

Those things are the pigs and cows that surrounded her in childhood, the two deceased daughters she thinks are still alive, and her parents' origins in Czechoslovakia, all of which she discusses repeatedly without prompting.

Hers is a restless, nonsensical mind masked by a pleasant demeanor and fit body. When leading Gonzales out the door after a half hour, her gentle interrogator is careful to mention she did very well.

"Oh, did I?" Gonzales says sweetly, quite willing to believe it.

Researchers are still trying to identify all of the environmental and biological factors that target some individuals for Alzheimer's and spare others. One thing they have deduced is that education and intelligence help delay the effects of the disease.

Smart people aren't spared the mental mayhem of Alzheimer's, but they appear to have reserves of brain power that help them function close to normal for longer periods.

"If you have a big vocabulary and you can't think of the word you need to use, you'll think of another one easier," said Dr. Judith Saxton, a University of Pittsburgh neuropsychologist. "It doesn't stop you from getting the disease, but maybe intelligence does what the medication is designed to do -- it slows things down."

At a recent Alzheimer Disease Research Center consensus conference where the staff collectively reviewed the status of patients, the doctors commented on the mental tenacity of a 57-year-old teacher with a master's degree. She was diagnosed with mild cognitive impairment nearly two years ago, but she kept awakening three hours early to prepare herself for classes so she could continue working.

Last month, the doctors downgraded her to Alzheimer's status, based on declining test scores and functioning. She has quit teaching. She's given up control of the family finances and can't drive 150 miles to visit relatives.

"I'm amazed she's hung on this long," a neurologist commented, recalling how the woman seemed on the verge of Alzheimer's in 1998.

Dr. Steven DeKosky, the center's director, recognized when he started seeing patients in the 1980s that his more educated patients held steady longer. "If the disease strikes you at 75 and you're highly educated, the sanding from the disease may never get down to the bare wood before you die," he said.

More commonly, however, someone goes from Irene Vellella's stage of functioning independently within a careful routine, to Mary Lewellyn's helpless status, to Mary Gonzales' ignorance of her helplessness, which is accompanied by an urge to wander away from home.

A nursing home is often the final stop. More than half of nursing home patients carry some sort of dementia, most commonly Alzheimer's.

Most are oblivious to their condition by that stage, which enables them to focus on activities that give them pleasure for the moment rather than the depressing fate awaiting them, said Dr. Jules Rosen, a Western Psychiatric Institute & Clinic geriatric psychiatrist. On his visits to institutions, he sees end-stage Alzheimer's patients retreat to a fetal position in bed, unable to care for themselves or take directions from others.

"Most people, given a good, supportive environment with caregivers who understand the situation, and with proper medications, their quality of life can persist for many, many years," Rosen said. "Eventually, they just become so debilitated, and the last few years are bad."

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Part Three: Burden of illness often heaviest for caregivers

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