Intestines and Brains

‘Why?’ you ask.  ‘Why are you looking into something as yucky as the intestines as a link to dementia?’  To be honest, it wasn’t something that had occurred to me before; I had never thought there could be a link.  Then, as we put Mom into hospice, she began to perk up.  I believed it was just a quirk of the disease, but then upon further investigation I learned it must be the yogurt.  

No, I’m not going to launch into an advert about a particular brand (although there is one I really like).  Yet, when the staff gave me her old yogurt (as the expiration date had passed and I needed to get her more) I just decided to try the “old stuff” - which was still rather tasty- and I began to feel much better.  Coincidence?  Perhaps, but upon further investigation I learned there is actually a link.  This is really interesting!

The link is called the brain-gut connection.  Think of it (facile as it may sound) this was:  You have a gut reaction, or you become stressed/nervous, and your stomach and guts begin to react accordingly.  It works just the opposite, as well - you eat something not so good and you begin to feel awful, have depression, anxiety, and a host of ailments.  These are linked, perhaps, by the diet and the involvement of the microbes and bacteria that should be thriving in your digestive ecosystem.   There are those who consider there is a second brain in the digestive tract, which is leading scientists to more discoveries than they had thought possible. (The Brain-Gut Connection)  

It’s all about the communication between the ENS (Enteric Nervous System) and the brain.  The gastrointestinal system is comprised of millions of nerve cells from the esophagus to the rectum (The Brain-Gut Connection).   Problems can arise in this region which could lead to mental issues.  Why?  Because there are more than 100 trillion microorganisms living in our bodies.  As the author in “I had the bacteria in my gut analysed. And this may be the …” states, these ‘critters’ need to be nurtured and fostered to be kept healthy.  Should they run into interference, then this is when problems begin to arise, both physically and mentally.  

As scientists begin exploring more into the neuroscience of the links between digestion and the brain, they find more and more information that could lead to some bigger findings that could affect more parts of the population than you might think. (The Neuroscience of the Gut)  And, yes, there seem to be some studies, too, that could link the possibility of dementia-like symptoms to diet, or even salmonella! (Alzheimer's-causing amyloid and bacteria trigger…)

It’s all very intriguing!  I know I could write and read so much about how diet affects our risks of dementia, but just knowing this - as well as having the knowledge of how insulin affects the brain - begins to help understand how important diet actually is.  I’m known for having a sweet tooth, at times, and I’m not always the healthiest eater - but since eating probiotic yogurt there is a shift in how I feel, act, and observe.  Could this be a little secret that might help keep the dementia boogeyman away?  Time will tell.

Everyday Dementia?

Trying to pinpoint a topic for today has been quite difficult; nothing seems to surface that grabs me - something that would interest a broader audience.  So, the solution is - - - - I don’t know.  

Sometimes there is no actual punch in the gut that causes passion, and my list of topics holds nothing either.  The one mental post-it on my mind, though, has to do with memories - do we remember what we fault them for lacking?

I look back on the years before Mom became ill (that we were aware) and smile at some of her antics - for example:

     We were visiting Universal Studios on our way out of LA from my brother’s wedding in the late 70’s.  It was fun.  We were walking by the amphitheater and could hear some rehearsing or something going on.  Mom, with her usual cavalier curiosity, decided to check it out.  The doors were unlocked and in she trotted.  Soon, we heard a woman’s voice ask, somewhat angrily, “What is that woman doing in here?”  Mom reappeared moments later with a security guard on either side.  Later I was to realize that was Donna Summers rehearsing her concert which was recorded and found its way onto my shelf.  

   There was the time we went hiking on the trail between Seaside and Cannon Beach - in the 60’s.  There had been some logging done in the vicinity and the trail became rather unfaithful and we found ourselves lost somewhere around Tillamook Head.  So, Mom, my brother, Tom, and I began walking the logging roads.  I had an apple but was saving it  for later.  Suddenly, a bear cub came wandering out and Mom grabbed that apple and threw it toward the cub.  She said she didn’t want to see me eaten.  I was too tired to care.  We finally found ourselves near the junction of Hwy 101 and 26, hitched a ride and rode back into Cannon Beach where my grandmother was holding the phone in her calls to the police.  We were fine.

   Again, in Cannon Beach, we decided to hike around Chapman Point to enjoy Crescent Beach, just below Ecola Park.  The water wasn’t that deep; but Mom had read the tides wrong, and we found ourselves, and our dog, Roxy, swimming between the rocks (my little legs weren’t long enough to touch sand, and Mom had me carrying the dog), until we made it safely back to the main beach.  It wasn’t my idea to carry the dog, but Mom told everyone I nearly drowned in saving the pooch...Hmmmm - not sure about that story.

  My brother enjoys the story of one day at the beach, we were renting at the time, we were supposed to be packing up and leaving - after cleaning - to allow for the next family to use the cabin.  Well, Mom and my grandmother decided it was simply too nice a day to go so soon.  They sat on the front porch and enjoyed the sun and waved at the next family who came to use the cabin (these people drove off - hopefully to return later after we’d left).  

Mom had her quirks, as I’m sure most people do.  She was also one to not look a gift horse in the mouth, but rather find the damn animal and make him present the gifts!  

Vacations were fun, in the early days.  Mom could be amiable - and then she could also be the opposite - we hoped for the former, but braced for the latter.  

I remember Mom and Dad dancing at the Elk’s Club in Eugene one evening when we visited my brother and his wife while he attended law school.  I don’t know I’d ever seen them dance that way before or since.  

I recall Mom dancing down the aisles of the supermarkets while humming the music - and when I told her it was embarrassing, she began to do it more ostentatiously.  

I would come home from high school and find her dusting the living room, wiping the keys on the piano and then trying to play a tune while singing - this was a once in a lifetime offering - and yet I saw it more than once.  She came unglued when she saw me, screaming in fright - which only made me laugh harder.  

So, when we talk about dementia, we speak of memory deterioration in the patient - but how many memories have we lost over the years, as well?  And how do we preserve them for others to enjoy or cherish?  If we don’t, then what real memory have we lost?

The Week Ending 10/25/2015

Mom at her friend, Nadya’s, a couple of years before her diagnosis

What can I say?  This was a week like most?  But it wasn’t.  There are some changes - some subtle, some a bit more apparent.  Mom still moves along, but if the past two days present themselves as a new normal, then it would be difficult to predict what’s next.

This week must have been a good one.  She seemed pleased to see me this morning.  She had just arisen (around 1130) and told me she would have slept in but certain people kept bothering her (Leddy told me she just checked on her a couple of times, but Mom didn’t like that; she gave Mom her meds and asked her about breakfast - that’s all).  

Last Sunday, my cousin, Chris came to visit Mom.  His father (our uncle) had passed over a year and a half ago from Parkinson’s.  He told me they had a pleasant visit (but I still need to contact him for more details, as of this writing).   My brother, too, came to see her and they had a rather normal visit.  

During the week, Mom did not participate in anything.  She did not want to do any of the activities presented to her.  Rather, she followed Leddy around and rebuked anyone who tried to refocus her (including Leddy!).

Morina and Jennifer were able to get her to shower (with help, of course), and Mom was pleased.  The photo demonstrates how Mom looks before Morina fluffs her hair.  

Wednesday brought Connie and Jean.  Here is their report:

We signed in at St. Anthony's just after 12 noon, after calling for help with the door that would not unlock.  Elsa came and fixed it.  It had not been closed all the way, so locked, but did not respond to using the code.

Norma was sitting alone at her usual table, reading The Oregonian.  She had the entire paper, which is not always the case.  (Or maybe she has it at first, but not when we arrive.)  Norma was wearing beige pants and the warm maroon shirt.  Her hair looked nice; Morina said she fluffs it up after Mom's shower.  That shirt shows every little "pill" and bits of white specks.

Morina showed us the after-shower picture and she sent it to Jean’s phone, too.

Connie set her walker in Norma's room, which was not locked.  The three of us had read Pat McEntee's  obituary already.  Lucille was seated at a nearby table, and Connie and Jean each hugged her.  One of the workers said she did not think Lucille registered what had happened, but we know she has to know or sense the huge change in her own life.

Connie brought a copy of the Weekly Standard and showed Norma Joseph Bottum's article on Classical England.  She also brought Norma a pretty net bag, holding a handmade wooden rosary and prayer booklets.  She offered to set it atop Norma's dresser, but Norma wanted to keep it with her.

A confused resident stopped by twice to chat, but Norma suggested she sit "over there on that couch," or do something else.  The same lady usually speaks to us, but we do not know what she's trying to say.  She leaves when it is "suggested."

Jean suggested going out to the garden. Norma said,"Okay," and we wondered about the temperature.Jean went outside, and realized it was not really that warm, and she would have had to get Connie's coat from the car.  We continued our visiting, and noticed Dr. Bunker apparently touring a young couple--probably

checking out St. Anthony's for a potential resident.  Dr.B. cheerily said to Norma, "You have visitors!"

Jean answered, "Yes, it's Wednesday."

We actually stayed there, just chatting, for two hours.  Norma was pleased to see us and content all of our time with her.  She had many interesting thoughts to share, interesting phrases which rarely got to home base. But we could see she was enjoying having us there, and we knew the wheels were turning in her mind.  Connie and Norma had coffee; it's nice to know we can just help ourselves, and can use the microwave anytime.

It was almost 2:30, and as Jean looked at her watch and said, "Connie, we must leave soon. I have a 3:30 doctor appointment."  (It was a lie, but Connie said it was okay in that case. Is that what you call Situational Ethics?)

We retrieved Connie's walker from Norma's room, and we said our goodbyes.  Norma gathered up Connie's gift and was ready to go with us.  "Can't you stay for lunch or dinner?" she asked. Jean hugged her and told her we will make a plan to do that--but it would not work today.  We headed for the door and did not look back.

On the way home, We knew it had been a pleasant time for all three of us, and with Norma engaged all that time.  And that counts for a lot.

During the majority of the week, Mom ate regularly - and all her meals.  This is quite good.  However, yesterday and today she began skipping breakfast.  She is complaining of her sciatica, although they do give her pain medication for this.  She is, as stated earlier, refusing to exercise or do any activity - even though they explain it will help reduce the pain (I do suppose that her following Leddy around  - possibly Morina, as well - might qualify as getting some walking in, though…).  Today, when I mentioned that Morina could help her she spat out a flat, “NO!”

Also, it would seem that she has been babbling a great deal more of late.  She just begins speaking about nothing and there is no connection to much of anything - this according to her workers who are there much more than am I.  

So, today, I sat with her and we chatted - mostly coherently with a few alterations.  I showed her some sweaters, I imagined she’d like, in the adverts.  She told me she wouldn’t be able to know unless she saw it and wore it.  That’s normal.  When I told her what I’d done around the house yesterday, she inquired if I had done that at St. A’s.  I told her that I had done it at my home but not at St. A’s.  She thought that inconsiderate.  That’s normal.

She ate her lunch while glowering across the room at her arch enemy whose family had just left.  She mumbled a few unpleasantries about her and when I asked if she could focus on something a little more positive she told me to mind my own business.  That’s normal.  

I then explained I needed to leave and do some shopping.  We had a short chat about that, and when I got up she asked where I was going.  We revisited the earlier conversation we’d just had.  That’s not normal.

Then, she did something out of the ordinary.  She told me to lean in so she could tell me something.  She reprimanded me and told me to never put her in a situation where she would get wet!  This was not normal, nor did I have a clue as to what she was referring - perhaps the shower?  I assured her I wouldn’t.  

I then kissed her on her pate and left.   A good visit. The question now is: What will the coming week(s) bring?

Environmental Risks and Dementia: Part III

See Also:  Part I      Part II

In researching this topic (Environmental Risks), there has been one underlying variable that I have left unmentioned - genetics.  The reason has been, thus far, that this is such a technical and detail-oriented topic that to be pithy is a bit challenging.   But after great thought and mulling about, I believe I might be able to do some justice to this topic for today (perhaps it will lead to more inquiry later).  

As I mentioned in the April 7, 2015, post, there are studies that link the susceptibility of dementia (or types) to genetics - making some people more predisposed than others.     Also, depending on your health, you could also be more prone if you don’t keep up a regular healthy diet, exercise, and refrain from many vices (e.g. smoking, drugs, etc); this depends on lifestyle.  But even if one were to live a quite healthy life it is no guarantee.  They also state those with greater education are less likely to develop dementia - so far in our family this has proven fruitless.  

At this time, there are studies on genetics and AD (Alzheimer’s Disease), that begin to help us understand how our own bodily environment can influence or expose us to such syndromes (Research into the causes of dementia).  There are also articles that articulate those very things that can make us more susceptible (Alzheimer Society of Risk factors).  But no articles actually refer to LBD (Lewy Body Dementia) at this time, or at least there are none I can find.  But there are those writings that help us understand the familial links (Alzheimer's & Dementia Risk Factors).

There is an article from the Alzheimer’s Society of the UK (Am I at risk of developing dementia?) which helps provide more information, and discusses fully  issues or habits that may increase your chances.   

So, rather than repeat what these worthy articles have put forth for us, I give you those articles to peruse and consider.  There’s really no need to recreate the wheel, now, is there?  Besides, you might uncover some treasures and begin asking some really great questions!  I’m game to hear them!  

Visitations and Their Impact on Dementia Patients

No one wants to be completely alone.  Of course, there are those who would rather be left alone, but still the phantom of human interaction persists for them - these are the patients who want the security of knowing there is someone there but have other reasons for being alone.  Then, there are those who are left without anyone except, perhaps, the caregivers.  While the interactions between them and other residents might qualify as a viable community, it does nothing for the impact of having friends and family come to chat and spend some time.

During my research, I discovered that there was a time in which nursing homes managed to keep families and other visitors from coming; they found the outside intrusions and possible interventions to be counterproductive to their wants and needs for the patients. (Family Involvement in Residential Long-Term Care: A …)   There was an attitude that people were simply “dumped” into these homes, and the family was discouraged from coming - and this impacted many greatly.  However, this attitude did change, obviously, as the population became more socially conscious, and more of the aged began needing more types of assistance - hence the need for Assisted Living, Memory Care, as well as Independent Living facilities.  

As the years have progressed, there are more and more facilities opening offering more opportunities for visitors, activities, and chances for the patients to explore.   This has had a significant impact on the patients, especially those in memory care, as this would be the focus of this post.  

The impact of visitors depends on the frequency, as well.  While the patient’s well-being seemed to improve, it also enhanced their feelings of belonging, support, and identity.  For the families, they felt far more connected to the care facility and had positive interactions with the majority of the staff, as well as with their loved one(s).  (Abstract)  While families still “dump” their elderly into facilities and do not visit (I’ve seen it, and it’s truly heart breaking), there are more that actually come and tend to the social well-being of their loved one(s). ( Impact on family and friends)

I’ve heard many state that they would go, but the patient is only a shell of what they once were.  I would have to say, “Hogwash! How would you know what’s there?  Perhaps there is a small part that is still clinging to the hope that one of their family members would at least acknowledge their existence!”  But, I suppose there’s nothing that can get through to them, either.  

There is also dog-therapy, which does bring more joy than not.   It can allow those with mild cognitive impairment (MCI) or early stage dementia to use different faculties that stimulate their brain and other senses.  Of course, these patients need to be prone to enjoying canine company, and the dogs need to be clean and trained.  But the joy on those faces when they can enjoy the presence of these animals is glorious!  While these may not be the same faces shown to family members, it still stimulates parts of the brain which release the endorphins and dopamine that help with the dementia (Get PDF (153K)).

I do remember Mom meeting my little Samson for the first time.  She fell in love.  Mom is not a dog lover, either.  But something about him charmed her.  She even wanted to have her friends meet him (I do believe this was a sign she was degenerating, but it was a very nice aspect at the time).  

Samson - the peke-a-poo

I have seen the effect of regular family visits with the other residents at St. A’s.  Those who haven’t the frequency tend to be more sullen and lost, while those who have regular visits are usually more vibrant and pleasant (I never thought I’d say that about Mom, but she is much more agreeable!).  Mom receives at least 3-5 visits a week, and she loves the hospice nurses and all the extra attention - but as I’ve stated many times, she believes herself to be of royal blood.  

So, if you know someone who is suffering from a form of dementia and it is possible to spend just a little time going to see them, please do - you’ll have no inkling as to the impact, but it may do  wonders for more than just them.

A Flipflop Fling? or Is The Shoe About to Drop? OR The Week Ending 10/18/2015

I received a call from hospice the other day, and the nurse stated that she believed Mom was doing quite well.  So, it was with positive anticipation I went to my visit today.  To be honest, I visited twice.   What I found was a very sleepy Momma.  

She participated thrice in activities this week, possibly four times (the aide was going to fetch her for BINGO today, but that was on hold).  She participated in a group chat for 30 minutes, earlier in the week, and then in 1:1 conversation for 20 minutes.  The truth is, she didn’t want to do much at all - compared with the past 2-3 weeks, this is a HUGE change!  

There will be some breaks with memories I just unearthed, to get a better view of Mum.

Top left - Counterclockwise:  1952, Mom with sons, Lawrence & Tommy; 196? in front of the rental cabin in Cannon Beach with Tommy, Dad, Mom, Grandaddy, Aunt Keiko, Me, Cousin Chris, and Cousin David; 195? Mom looking like a happy housewife (how they did that gives pause); Mom, Chris and Me - possibly Shuswap Lake, BC.

Mom has been eating well, missing only dinner on Friday.  When I spoke with Ledi, she stated they were thinking about Mom going off hospice, but nothing was mentioned to me about that.  It is true she seems quite with it - in her reality, but there is that nagging suspicion that  something is going to happen - and happen it will!

1951 - Mom with the Baby Lawrence.

1952 - Mom playing beach bunny.

Here is the missive sent by Jean this week, and her comments:

Dear Tony,

I did get myself on the road today for St. Anthony's. I forgot to take a pill before leaving, and my foot was a nagging pain.

Norma was sitting at her/our table, facing Rosemary.  Lunch was over; Norma still had half a glass of water and the empty coffee cup.  She raised her eyebrows (in delight, I think) and smiled when she saw me.  She was wearing light beige pants and a maroon warm pullover shirt.

I sat with the ladies for a while; Rosemary answered with her name when Norma asked her.  She was quiet otherwise.  Norma often speaks quite softly when others are near; at times she has told me to lower my voice, as a privacy issue. I do as told, of course. She was chatty, expressing views about different things--in phrases only, and so softly I could not always hear her.  She said something about having gone  somewhere (?) on a warm day.

I suggested going outside in the warm sunshine. She stood up, said her lower back hurt.  We walked to the TV area, where she settled down on a black recliner--did not try to lift the foot area.  So I sat down on the other black recliner.  We watched people walking around,  with Leah going back and forth several times, saying little.  I  always smile and sometimes say ‘Hello’ to other residents, but Norma tells me not to do that. She does not want to encourage them to chat or stay with us.

Beautiful new brown shoes!  I asked if they are comfortable. Norma said they were actually made there, or someplace near there that St.A's owns.  No support hose on, but why were her ankles wrapped with white wrappings? Her ankles look swollen; or is it those wrappings?

When we stood, I tried again for a garden visit.  "We can sit on that wooden bench and enjoy the warm sunshine." No takers. We went into her room.  She sat on a dining room chair next to her chair.  Said she did not take it there, but something about why it was there; I did not follow her thoughts there.  I told her I had to do something and handed her that calendar with the beautiful garden pictures. Then I skipped out (Jean is experiencing some painful medical issues, so this makes sense).

Today, when I visited Mom was asleep at her table with her paper in front of her.  Rosemary was seated next to her - same (asleep with paper in front of her).  The table near them was full of resident ladies all chitting the chat and smiling radiantly.  I touched Mom’s leg and she came around.  She was surprised to see me but stated that she was extremely tired.  Then she went to reading her paper.  I would ask her questions or remark on something and she would respond - but then went back to the paper.  I then suggested I would come back later.  

“Where are you going?”

“Taking the dogs for a hike”

“If you wait a few minutes, I’ll go with you!”  (this was unexpected and a very bad idea!!!!!)

“Well, I’m not sure the weather is good enough for you to go, and you seem very tired.”

“Stop speaking nastily about people!”

I then decided to pretend to get something from the car (knowing she’d forget the exchange as well as my presence), and left.  

I re-entered about 3 hours later and she was still in her seat at the table (after having indulged in lunch) with the paper in front of her (still, but on a different page).  I told her I would check in with Ledi while she finished up.  In two minutes, she was by my side telling me we needed to get going so we could load the car (your guess is as good as mine!).  I took her to her room (she did state, “Through that door is my home - this place is my home, and these people take advantage of my kindness!”) where she entered and crawled into bed.  She just lay there.  

I offered to put on some music, but she stated that many people would find that type of statement offensive.  So, I told her I was going to do it - and did.  She found it restful.  We talked about the changing colors in the garden, but she seemed more interested in what was under her eyelids.  So, I told her I was going to check on the food so we could start loading it.  She thought this a good idea.  I left to speak to Ledi about her activity journals that week.  

    When I returned, she was fast asleep.  

I’m not sure what is going to happen next, or if this lack of participation and willingness to do anything is a sign.  She was in a very good mood this week.  One resident, Pat, died yesterday, and Mom knew him from childhood, and his wife from college at Marylhurst.  Mom seemed not to be aware.  

This week will quite possibly be the one that tells us more - we know she’s declining but at what pace?  Does this mean she’s about to cascade?

As I left, I also knew my brother was coming for a visit, as was my cousin Chris from Seattle (his father died of Parkinson’s last year).  So, not only was she in good hands, but she would have plenty of attention!  

We will see how that worked, later!

Environmental Risks and Dementia: Part Two

Last week, in Part One, I pointed out the influence of metals, namely lead and aluminum, on being one of the suspected causes of dementia.  Someone asked me, the other day, “Just when do you suspect we breathe in or ingest lead?”  Well, that leads me to the topic of today:  Air Pollution.  

There is an interesting article in Mother Jones, in which the story (a brief one, should you care to read it) points out that in certain situations there are millions of particles in the air that you breathe in - particulates of different compounds (such as diesel, lead, plastics, chemicals, ash, etc) which can enter the bloodstream through your lungs (The Terrifying Truth About Air Pollution and Dementia).    As these enter your lungs, they not only might enter the bloodstream and then, possibly, cross the blood-brain barrier but can also impede blood flow to the brain.

According to an article from The Fisher Center for Alzheimer’s Research Foundation (Air Pollution May Raise Dementia Risk) the risks associated with pollution can not only create more dysfunction in the brain but also in the heart and other cardiovascular issues.  

 In April of 2015, Newsmax published an article which, too, articulated the findings that long-term exposure to pollution can be attributed to one to two years of brain aging, and, with the other articles mentioned in this post, attribute the effects to mini-strokes which may not even be noticed among older persons, primarily.  

To the fact, as well, that studies of late have also uncovered that children exposed to a great deal of pollution are susceptible to learning difficulties, as well, so this isn’t just an older person's malaise (Smog in our brains).  And we know that most children seem to be able to overcome these issues - or are they just staving off the effects until they are older?   What was discovered in the article published by the American Psychological Association was that mice, exposed 8 hours a day 5 days a week (much as a suburbanite working in a smoggy city) began demonstrating slower abilities to problem solve - in fact, they were found to have few connections in their brains and their brains were beginning to demonstrate signs of shrinkage and decline.

What determines a smoggy city compared with one with cleaner air?  According to Time Magazine, these are the 10 worst cities in 2015:

1. Los Angeles-Long Beach, CA

2. Visalia-Porterville-Hanford, CA

3. Bakersfield, CA

4. Fresno-Madera, CA

5. Sacramento-Roseville, CA

6. Houston-The Woodlands, TX

7. Dallas-Fort Worth, TX-OK

8. Modesto-Merced, CA

9. Las Vegas-Henderson, NV-AZ

10. Phoenix-Mesa-Scottsdale, AZ

And, according to further studies, simply living along a well-traveled road in the country could also be causal to suffer the effects.  Is it no wonder that being out in nature, at the beach, or somewhere away from civilization makes us feel so free and hale?

So, in a nutshell, the exposure so many of us are prone to experience, means that, perhaps, we will begin a mental decline at some  point - earlier than what we may have actually been determined to have at birth.   Solution?  Retire to a small island away from industry - lots of breezes and fresh air!

See Also Environmental Risk Factors for Dementia Part One
               Environmental Risk Factors for Dementia Part Three