Sundowning Syndrome - What Is It?

I recall one of the first times Mom experienced Sundowning Syndrome in my presence.  She began asking me where her mother was.  While this took me aback, I answered as truthfully as possible, which only led to her becoming upset.  Later, there were phone calls, which could also be determined as Sundowning, in which she would demand her mother’s phone number.  She had tried her old number and found it wasn’t any good any longer - so she would phone my brother or me for the information.  

One of her friends had also phoned me as she had seen it happening.  As Mom declined at home the syndrome became more prevalent.  I had to begin asking whether or not this was symptomatic of Alzheimer’s and Dementia? or was it simply caused by age?

No one truly knows the actual reason for the phenomenon.  It affects 1 in 4 Alzheimer’s patients, and it also affects many who are not succumbing to dementia.  This has left the medical community with a puzzle.  However, what they do know is that there is such a thing and it seems to begin around 6 pm nightly.  

What is Sundowning?    

Sundowning is represented by late-afternoon, early evening changes in the person.  This is exhibited by:

• Agitation
• Restlessness
• Irritability
• Confusion
• Disorientation
• Being Demanding (more so in cases like Mom)
• Suspiciousness

It may also include:

• Yelling
• Pacing
• Hearing/Seeing Things (Delusions or Hallucinations)
• Mood Swings
• Ataxia (the lack of control during voluntary movements, such as walking or picking up objects.  A sign of an underlying condition, Ataxia can affect movement, speech, eye movement, and swallowing)  A Caregiver's Guide to Sundown Syndrome

Sundown Syndrome in Persons with Dementia: An Update

Also, some of these symptoms may not necessarily be caused by Sundowning, but rather “manifestations of dementia, delirium, Parkinson's disease, and sleep disturbances.  Sundown Syndrome in Persons with Dementia: An Update

There are theories that either pronounced age, later age hormonal fluctuations, or the root causes of the dementia have toyed with the person’s circadian clock.  This is the organic clock that allows the body to coordinate biological activities in the day-night cycle.  But, then again, this isn’t well-documented and is only a theory, as are most causes at this time.

What they also have determined, though, is that light stimulation begins to decrease at a certain point in the day which can trigger confusion with the loss of light and growth of shadows.   

Some of the triggers that have been noticed are:

• Fatigue
• Depression
• Boredom
• Pain
• Hunger/Thirst
• Low Lighting
• Shadows
• Disruption of the body’s internal clock
• Difficulty separating reality from dreams
• Confusion Surrounding Increased Activity
• Confusion Surrounding Changes

The last two on the list may have more effect on those who have caregivers in a facility or home, where the staff changes occur later in the day.

Patients may begin following staff, have troubles with redirection, become agitated, and wandering.  

There have been studies in which there has been promise by giving the patients melatonin, but then further exploration denied those conclusions.  

According to the National Institutes of Health and Aging, the following are acceptable interventions to use in preventing and controlling the syndrome:

• Light Therapy
• Aromatherapy
• Music Therapy
• Caregiver Education
• Multisensory Stimulation
• Simulated Presence Therapy
• Following Sleep Hygiene Routine
• Structured Daily Routine with Strict Adherence
• Physical Exercise

Sundown Syndrome in Persons with Dementia: An Update

There seems to be no real effect in using any drug therapy at this time.

So, This is my little synopsis of the syndrome.  I’m hoping you learnt something along the way!

Guest Post: The RLC's Weekly Visit with Mom, or The Week Ending 07/21/2015

As I was out of town this weekend, and unable to visit Mother (we've an appointment this week with the doctor, so that will bring some news, perhaps) I decided it best to have Jean, Mom's diaper buddy, write the post for today.  It's always good to have another perspective!

from over a year ago - happier days, but the RLC still pulls through!
L-R  Mom, Jean Mitchell, Connie Manning

Dear Tony,

Connie and I checked in abut 1:15 at St. Anthony's to see Norma. Mike Manning, the cottage director, came to welcome back
Connie, after her two-month absence recovering from a fall.

We found Norma in her room, and as always, she was glad to see us.  Since Connie is using a walker now, she has her own chair, which was handy in that room with only one chair for visitors. 

We chatted about new revelations about Pluto, looking forward to news stories. Norma said the piano-sized probe sent to learn about Pluto is traveling at 3,000 miles per hour.   At that rate it will be nine years before it is close enough(6,000 miles) to gather data about the non-planet.  She reads her Oregonian.

Norma spoke of some of the mysteries of the universe, as did Connie. I listened and learned.  We agreed that in heaven we will know all the answers to questions we have now.  We did not think there are  people on any planets but our own.

Norma said she was angry with her mother, but did not specify about what.  We asked her why, then she was on to another topic.

Norma spoke of the 19th Avenue house as if she was still there at times, then used the past tense other times.  I asked if her Grandpa Hodges,the editor at The Oregonian, was the one who wrote "that book."

Yes, he wrote "20 Eventful Years," with no hesitation.

Connie told us about a 4-day stay in Providence Hospital about a month after her fall at St.A's (which Norma does not remember). She was having headaches, a sign of problems, so had to stay in hospital for observation. I don't know what results there were from the tests, but Connie feels fine now.

Norma offered us Diet Pepsi, none of which was in the fridge, but atop it in the long box it came in.

I got paper cups and ice from the little kitchen off the great room, and we shared two cans among the three of us.  There were no oranges there; they can sometimes be found in a cupboard.

I put the white and the red dahlias in two vases.  Norma's windowsills have several flowers, real and fake, with lots of color. We talked about a way to give her a better view of the garden. I mentioned cup hooks.

We went outside, sat on the bench in the sun.  Josepha brought us each a popsicle, then I got wet paper towels to wipe off our sticky fingers.  Later Josepha brought us each a big cookie, then a glass of juice.  Norma drank half her juice, then said I should drink the rest.  I refused politely. We are treated very well at St. A's.

Outside we admired trees, plants and flowers, especially the lovely varieties of hostas not far from Norma's room.

Norma said she would come with us when we said it was time to leave.We said we could not take her; I reminded her dinner would be soon.  She was okay with that, unlike many other times when she really wants to leave with us.  We left after 4 pm.

Connie saw some decline in Norma's condition. But some of Norma's conversation was sensible and interesting.  It was a good visit. Norma was alert most of the time, closed her eyes in the warmth outside at times.

Blessings,

Jean

Note:  This trio of friends has that type of friendship where they hadn't seen each other in years, but stayed in touch through notes, mail, calls, and such.  When they used to get together it was a gabfest of great glee!  It's so nice they're there for each other when the ocassion arises!  

Book Review: When Troubles Fall Like Lemon Drops: Encountering Lewy Body Dementia - Ruth Roberts Johnstone

When I first saw Mrs. Johnstone's blog title I was amused and hopeful.  Her picture showed a smiling woman who had to have been able to rise above all the stress involved in dealing with an LBD patient.  I heartily ordered her book through her blog site and waited.

When the book arrived days later, I ripped open the envelope, put on some classical reading music, and began.

The book begins in earnest to outline the history of Pastor and Mrs. Johnstone and their lives as missionaries, who came to a small town in Alberta, Canada to minister at the church there.  This wasn't long lived, as Pastor Johnstone began to decline into Lewy Body Dementia and Mrs. Johnstone needed to find ways to manage her life (without his income) and his care.

I must hand it to Mrs. J, she really was able to work hard and bring herself up; but aside from the history of the family, their trials and tribulations, there isn't really much said to address her husband's illness, to the point of not knowing if he was still alive by the end of the book.

She and her husband had a good marriage.  They were both very supportive of each other and he was a very kind, gentle soul.  It was quite a shock when he began to decline and left the community and his family at a loss.  However, the strength of the book comes from Mrs. Johnstone's ability to rebuild herself and stay afloat while handling her husband's illness, helping their children, and keeping body and soul together.

This book has an inner strength to it, with homespun adages and a will to survive and succeed, despite the obstacles life presents.   Mrs. Johnstone took many of her blog posts (from the site with the same title, When Troubles Fall like Lemon Drops, and adds to them.  The story has flow and purpose, as does her life and philosophy.

It is a sweet book.  However, there is very little information about the disease, rather a journey through the eyes of one caregiving survivor, which is important, as well.

This was a quick memoir to read, and gave me a great deal to consider.


When Troubles Fall Like Lemon Drops.  Ruth Roberts Johnstone.  2015.  162 pp.

You may find the book at these resources:

When Troubles Fall Like Lemon Drops 

Christian Books.com

Amazon

Hide And Seek!

If you recall, Sunday, Mom refused to arise and shine from bed.  However, the next day she was up and about as though nothing had happened.    These things happen - although I’m still searching for some answers/clues that could help me understand.  

Today, though, I thought we’d talk about a phenomenon that began within weeks of Mom’s placement at St. A’s.  While this is not peculiar to her, it is with LBD patients, believe it or not.  

Mom used to have a perfect place for everything, and before her decline (at her home) she would have everything pretty much in its place (no, she wasn’t one of those who obsessed over the perfect arrangement with spot-on placement).  She knew where things were.  

Now, with her dementia advancing, Mom has very little idea where much is, nor what she has.   She began, simply enough, with her purse.  One morning when I came to fetch her she complained that she didn’t know where her purse was.  We looked everywhere around her room.  Finally, after all the obvious places, drawers, under the bed and other furniture, in the hamper, under cushions, etc., I found it tucked under her bed pillows.   She laughed - “How could I have put it there!?” she wondered aloud.  

Well, things have progressed.  

Not long ago, the LPN, who manages the place, begged me to make a key for Mom’s room so they didn’t have to keep unlocking it for her (she locks it to keep everyone out as she believes they wander in and take things).  I told him I would, but it wouldn’t make a bit of difference - she’d put it away and we’d probably never see it again until she died.  He scoffed.  

So, I did it.  I put it on a coiley-type band and gave it to her.  I had her use it even.  The next day it had vanished and she hadn’t any notion to what I was referring when I asked about it.  I spoke to the LPN and told him.  He heaved a heavy sigh with acceptance and resignation.  

Mother’s room has since become quite the black hole for many things:  glasses, cards, videos, vases, silverware, pencils...you name it, it’s probably stashed somewhere in there and you’ll be hard pressed to locate it.  

Mom has taken to putting magazines, bags, letters, kleenex, and whatever, into boxes.  I do go through many of these and toss out the garbage (which she tells me are still useful - but I don’t believe wadded up tissues, apparently used, would be of healthful use to anyone) and figure out what to do with the rest.  

Mom hadn’t lived in Oregon for nearly 25 years so she doesn’t remember the bottle bill - all her pop cans end up in the garbage, but I believe the staff picks them out and deals with them appropriately.  

There are some things Mom does keep organized, though - Her watch stays by her bed in the little lacquered box from Japan.  Her purse is always somewhere - it’s something enjoyable to locate.   Her glasses are a challenge - every time I visit there seem to be more pairs in her drawers than the time before;  this includes sunglasses which I can’t remember her wearing at all in the past 20 years.  Dirty clothes can be found in the drawers or on the hangers- she doesn’t want them washed as she doesn’t see the need - they never get dirty, she says (HA!  They’re filthy!) so I have the staff rummage through her drawers and closet to wash as much as possible while we’re out.  Everything for the bathroom stays there - it never leaves, so that makes that rather uncomplicated.  

Mom has also decided that her little mandarin oranges need to be out of the fridge and they are to be found in the cabinets, drawers, closet, or wherever she can think of.  Luckily the soda stays in the fridge.  

There was a point when the staff requested I buy her more <ahem> private panties <cough cough> but I knew she had more than enough.  Apparently she was hiding these wherever she could to avoid the embarrassment of anyone discovering she may have had an accident or two.  

How oddly the brain works.  She asks me to fetch things from the basement for her - so I leave for a couple of minutes and come back, knowing she will have forgotten.  

They say this is considered something of an Obsessive Compulsive Disorder, but this actually bypassed my understanding.  Others call it Hide-N-Seek.  It’s pretty typical for the LBD patient.

I honestly find it a great diversion - I never know what I’ll uncover while searching for something relevant - and her reactions are always unpredictable.  But that’s for another time.   

The Week Ending 07/12/2015

There is something to be said of the brain.  It can function in ways that are mysterious - portions may still remain while others are failing.  Much like a fortress under attack, not every room or section has yet been affected.  So it is with Mom at this date.

On Wednesday, Mom was visited by Jean, who was driven by her son, Tim, in his air-conditioned car so she wouldn't suffer the heat (her car had said goodbye to her a/c).   When she arrived, she found Mother sitting at the table in the great room working her crossword.

Jean marveled at how quickly and adeptly Mom was able to read the clues aloud, then marking the spaces just as well.  They worked together sitting quite closely.  Jean joked that, perhaps, she should sit in Mom's lap.  Mom laughed and told her, "No!"  A light-hearted visit.

Jean had brought some hydrangeas and put them in vases for Mom's room.

Mom at the beach.  Taken by her friend, Nadya (ca 2007?)

Mom was wearing her deep-red plush sweatshirt despite the heat.  She hasn't a clue as to the temperatures outside and is always a bit chilly.

After a short visit, Jean's son texted her that he was outside waiting.  She said goodbye and Mom said nothing about coming with her.  It was a fairly easy exit.

Today, it was a different story, but maybe not.

Mom wasn't truly full of pep when Jean went for her visit.  Today, though, they couldn't get her out of bed!  When I notified them of her pick up time, they stated they were trying to get her up to take a shower.  Well, that went south before it ever happened!

Mom spent her entire day in bed.  When my brother went to pick her up he stated that her speech was more muddled and softer than it had been.  Not only that, but her eyelids kept fluttering while she spoke and then she drifted off to sleep in mid-speech.

While I've seen this once before - but I was able to coax her into coming with me (she wasn't in bed but her chair), it wasn't this bad.  Perhaps the day before I came she had been like this - she hadn't arisen at all.

What this means I haven't a clue.  However, a call tomorrow will be warranted, to see if we can monitor her further and see what may be happening.

Book Review: We Are Not Ourselves - by Matthew Thomas

While wading through the information on Dementia, and trying to locate anything that would provide answers, there is something about reading a novel that provides support for those who are dealing with such an issue.  At first, I was hesitant.  Did I really need to read something that would trigger any response emotionally or psychically?  But one of the many voices in my head (no, I'm not schizophrenic) kept at me to give it a go.  I found the book worthwhile and it did give me a great deal to consider.

The story follows the life of Eileen Leary, the daughter of immigrants, who marries a neuroscientist.  While their lives are far from perfect, they reflect those of the average couple with their trials and tribulations;  their highs and lows.

Her husband, rather than work for the pharmaceutical companies, chooses to become a teacher.  Their background in medicine and their Irish heritage is where the commonalities end, as they are polar opposites of each other.

Eventually, Ed, her husband, begins to decline into dementia.  Eileen and their son, Connell, struggle to understand and deal with the issues that are raised.  In fact, Connell is visiting his father's lecture hall when there is an episode of memory loss that leaves everyone greatly confused.  The irony is that Ed's research has been on dementias and the like.

The novel encompasses Eileen's struggles to be wife, mother, nurse, and friend while dealing with their home life and maintaining a level of normalcy.   The isolation that evolves with close friends and others reflects that of those who become caregivers and need more support, rather than being left alone.

The book manages to explore the relationships, frustrations, and daily lives of these characters in a viable and realistic manner.  This is greatly appreciated as the focus isn't necessarily on the affliction, which becomes something of a character, but on the pathos of the family as they struggle and find ways to deal with the issues at hand - not always understanding, nor always being empathetic.

The novel begins while Eileen is a young girl, learning to survive in a world that isn't necessarily friendly.  Her parents have their problems, but her relationships with them bring her a resolve that lasts a lifetime.   She is practical and thinks through every decision.

She marries Ed, and even though he isn't neccessarily the Prince Charming she'd hoped for, she begins to learn and accept.   While they work hard and learn to keep their relationship going - neither is going to give up despite all the obstacles - there is more than a hint  of foreshadowing that occurs.

As Ed begins his decline, Eileen and their son, Connell, try to make sense of what is happening.  There is a sense of guilt, responsibility, anger, and acceptance that manifests in very human ways.  It's as though, throughout the novel, Matthew Thomas understands all the relationships that occur and lays them out in an honest portrayal.

I would recommend this book to anyone wondering what it is like to live a daily life while attempting to provide care  for someone whose disease isn't completely understood.    It bears in mind that the patient isn't always cooperative or understanding, either, and there are times when the cup has run dry and Eileen wants to give up.    There is good reason this was on the best seller list for so long.

So, if you want to read something uplifting, this probably isn't the book.   However, if you enjoy reading about real people and real struggles that mimic those of many in the community, and wish to have better understanding of the situation and what it could be, then you should definitely read this book.

Official Page:  We Are Not Ourselves - Matthew Thomas.  Simon & Shuster.  2014.  640 pp.

The book is available on:

Amazon - Kindle, Hardback, Paperback, Audio CD
Audible
Powell's City of Books - Used
Barnes & Noble - Hardcover, Paperback, Nookbook, Audio CD

Mild Cognitive Impairment (MCI) - Some Useful Information

1. Mild cognitive impairment (MCI) is an intermediate stage between the expected cognitive decline of normal aging and the most serious decline of dementia. It can involve problems with memory, language, thinking and judgment that are greater than normal age-related changes.

As we age we many of us become very good a filtering what we remember.  There are also many times we are on overload with information so some of it is lost in the shuffle.  Much of this is natural and cannot be seen as any sort of impairment or decline - we choose to “file away” that which is relevant and can be used later.

With Mild Cognitive Impairment, things begin to change, though.    According to the Mayo Clinic (Mild Cognitive Impairment: Practice Essentials, Overview …)  the symptoms are as follows:

Your brain, like the rest of your body, changes as you grow older. Many people notice gradually increasing forgetfulness as they age. It may take longer to think of a word or to recall a person's name.

But consistent or increasing concern about your mental performance may suggest mild cognitive impairment (MCI). Cognitive issues may go beyond what's expected and indicate possible MCI if you experience any or all of the following:

• You forget things more often.
• You forget important events such as appointments or social engagements.
• You lose your train of thought or the thread of conversations, books or movies.
• You feel increasingly overwhelmed by making decisions, planning steps to accomplish a task or interpreting instructions.
• You start to have trouble finding your way around familiar environments.
• You become more impulsive or show increasingly poor judgment.
• Your family and friends notice any of these changes.

If you have MCI, you may also experience:

• Depression
• Irritability and aggression
• Anxiety
• Apathy

These symptoms may be linked to a future onset of Alzheimer’s and Lewy Body Dementia but without testing and finding oneself on a downward spiral, this may not necessarily be the case.    While the indicators demonstrate that the beta-amyloid plaques or Lewy bodies may be causing this, it could also be the result of small strokes resulting in mild vascular dementia, as well.  

In England, according to Ken Clasper, who was originally diagnosed with LBD and then, after 10 years, was re-diagnosed with MCI, the National Health determined that those with diagnoses of dementia who were still able to function at some higher level were reduced in their diagnosis to MCI.  While perplexing, it does make sense on some levels.    There are other issues this brings up, but for the purposes of this blog and post, I’d like to keep it simple.

To bring this to Mom, saying she exhibited signs of MCI earlier makes sense.  People began asking about her and wondering if she was, indeed, doing fine.  Of course, we determined she was simply aging and the process was taking a natural toll on her mind and thinking processes.  

However, in retrospect, perhaps we weren’t taking it seriously enough, or despite the signs, didn’t fully understand the full purport of the condition.  Nevertheless, while it could have been benign and simply caused by the aging process, how were we to determine otherwise.  

According to the United Kingdom chapter of the Alzheimer’s Society,

A lot of research has focused on identifying people with MCI who will go on to develop dementia. This is important because it would mean that people could be offered a range of support at an early stage in the illness. In the future, for example, researchers might seek to develop drugs to prevent the progression of MCI to dementia.

Researchers have tried to identify people with MCI who will progress to developAlzheimer's disease by using different types of scans, including magnetic resonance imaging (MRI). These help to detect changes in brain structure and activity. A different approach is to measure the concentration of proteins in the cerebrospinal fluid, which circulates around the brain and spinal cord. These proteins are studied because they may reveal that the changes in the brain seen in Alzheimer's disease are already underway. Some of these techniques show promise, and some are beginning to be introduced into routine use by doctors. This is, however, an area of ongoing research and it is not yet possible to predict with certainty whether a person with the memory loss type of MCI will develop Alzheimer's disease.

Research to identify which people with non-memory loss MCI will go on to develop dementia is progressing but is much less advanced.

(Mild cognitive impairment)

In short, if you know or have someone who is beginning to exhibit signs at an earlier age than what you may believe to be normal, and there are indications that things aren’t quite falling into place, you may want to encourage a check-up.  It’s not that doctors are armed with the best tools to make any real form of prognosis, but at least you may be able to begin making some judgments and calls that could ease the future.  

Fireworks, Salad Talk, and The Week Ending 07/05/2015

The week went past with Mom engaged in her Crosswords, Bingo, and regular activities.

Jean came for a visit in which she re-arranged the flowers in Mom's room, and then they sat in the great room to do the jumble and crosswords.  Mom had some difficulty doing the jumble, but she attempted it!  Then, moving onto the crossword, she attacked it with vigor.  She and Jean enjoyed a nice discourse while solving the clues, Mom mostly entering the letters into the correct boxes, more often than not.

One of the residents, Lucile, who has severe AD, sat at the table dealing with her lunch when her husband was escorted in to join her.  He was diagnosed just last year.   And now he has some heart issues - he's not doing well, but he is a very happy and jolly soul.    I know he's still in assisted living and I wondered for some time as to why he hasn't been placed in the same room as she.  Then it occurred to me that, despite their diagnoses, each needs their own personalized care.   Were they to be together and something happened, it would create more problems than it solved.  Sad.

Mom had no inclination to go for a walk.  I do know she enjoys walking to Bingo, which is a hike through the facility, but her interests are fading insofar as doing anything that isn't in her normal range of action now.

She has bathed in the past week, and the trick seems to be that if they catch her before she dresses there isn't a problem.  Wine, ice cream, and expected visitations have no effect;  she doesn't recall them long enough to make much of a difference.

Yesterday was the 4th, and of course, fireworks.  Today Mom didn't recall anything, but I was told she was demanding that people stop hammering and banging on things last night.  Another resident, Barbara, also made the same complaints.  Of course it was only the banging of the fireworks.  Good to know Norma Regina is still in charge, though.

This morning it seemed an eternity for her to come out of the bathroom.  I was told she had been convinced to take a shower, but that she refused to wear clean clothes.  We kept popping into her room to make sure she was still alive and her voice resonated well from behind the bathroom door.  She was dressing, she said. Well, at least her person was clean.

it seemed, too, an eternity for her to get herself ready to leave.  I was able to get her compression stockings on and then her sandals.  Next, she demanded to have a jacket despite being told it was going to be well into the 90's out today.  Her response?  "Well, just remember how the Eskimos would dress in that sort of weather!"  Catch my drift?!

We were able to leave with a sweater draped over her arm.  Once outside she complained of the heat and told me I hadn't told her it was this warm - only that it was cool and comfortable.  <sigh>  But once underway she was content.

We were stopped, on the way, by a train and several minutes later, at Jean's, she was asked about it.  She had no idea what we were talking about.    We had to wait it out for nearly 10 minutes and she kept remarking about how long it was.  Funny how quickly she forgets.

As we neared Jean's house we passed a massive three-story house on a very large lot.
"My goodness that house is HUGE!" I stated.
"That little thing?  It's not very big at all," she declared.
"Are we talking about the same house?"
We were.  I'm not sure if this was back to her old habit of contradicting everything I said or if her processors were off

We arrived at Jean's, and she had a little trouble going up the steps, but somehow managed.

Her thoughts were (as one of her nurses stated) salad:  all mixed up but she was still making an overall point.  Her voice wasn't very clear, either.

She did look a bit tired.

She wasn't very interested in lunch; she just picked at it and then offered it to me, thinking me rude to decline (but I'd already had mine).


Later, Terry and his daughter, Jada came to visit.  Jada had just come from England on a tour.  We began discussing the country and sites and Terry asked Mom if she'd ever been there (usually Mom has no recollection of ever going anywhere outside of the US, let alone many places in the US).  Mom began chatting in a regular voice, making full sentences and spoke with clarity.  It was pretty amazing!

We left after a bit and arrived back at St. A's.  She went into her cooled room (68 degrees) and sat down to rest.

She had a pretty good day.

Some thoughts:

Mom thought I should send my great-grandfather a Christmas card to cheer him up.  She said he thought I was neglectful.  I never met him.

Mom also spoke of her cousins and siblings.  None of what she said made much sense, but apparently they were all having a wonderful time.

She asked about Jean's mom as we drove, and  I told her that Ruth (Jean's mom) and my grandmother were doing something today and were feeling quite lively.  Mom agreed and stated that her mother had told her they were going to be working in the garden today.  How grand!

As we left the car at Jean's, too, Mom suddenly rebuked me.  I hadn't said anything much within the last few minutes except for her to tell me how to help her out of the car.  "You need to stop saying nasty things about people and their families!" she snarled.  Now, this came from nowhere.  There had been no comments or discussions about anyone except the evil drivers who chose to move at 20 mph below the limit on the streets.  Oh well.

Gender Differences in Dementia - More Research and Even More Answers...Part C/D

Click here for Part A/B, in case you missed it earlier in the week.

Now that we've established the differences in brain size and matter between the two genders, there is also exploration of how the sex hormones may affect the development and reaction to LBD, AD, PD, and other forms of dementia.

According to the Society for Neuroscience (2006), they did discover there were more commonaities between women suffering from Parkinson's (PD) and Lewy Body Dementia (LBD), than between men suffering from the two afflictions.  While this leads to more questions, perhaps if we follow this winding path we  may be able to uncover more answers and discover more questions.

Let's move back to the womb, just as a starting point, in order to understand the brain differences.

     Sexual differentiation of the brain is cuased by sex hormones acting in fetal and early postnatal 
     life,   although recent evidence points to genes onthe & chormomes contributing to this process.  

     Sex differences go well beyond sexual behavior and reporduction and affect many brain regions 
     and functinos, ranging from mechanisms for percieving pain and dealing with stess to strategies  
     for solving  cognitive problems.  Although differences exist, the brains of men and women are 
     more similar than they  are different.  (The Neuron.Society for Neuroscience. page 9. 
     Washington.  2008)

So, as we advance through life from the day of birth we are influenced by those hormones and chromosomes.   They truly influence so much about us without our even being aware.  This also contributes to thinking processes and behavior, as well as development and growth.

There are also studies which deal with women and Hormone Replacement Therapy (HRT).  According to  Healthday, HRT was found to contribute to a greater risk of dementia in women, as well as breast cancer, asthma, heart conditions among a vareity of other problems.

According to the National Institutes of Health, women who took HRT post-menopause or around age 65 were twice as likely to develop AD (Alzheimer's) as those who didn't.  There are still studies examining the effects on those who take it pre-menopause and during the phase.      There is evidence, too that should the HRT take place within 10 years before age 63 the risk-level was lowered (Hormonal Influences on Cognition and Risks for Alzheimer's).

Now, what about men and testosterone?  Well, According to the International Society for Sexual Medicine there is a link.  Men with low testosterone levels were more prone to AD and this greatly increased if they were over 80 and had higher levels of education.   Women and testosterone demonstrated increased verbal capacity and memory.  This is being studied further, as the evidence points to testosterone actually working as a brain protector.  There are also some blog posts in which there is evidence that it can aid those suffering from MCI (Mild Cognitive Impairment).

Now, as to why more men are susceptible to Parkinson's and Lewy Body Dementia (PD & LBD), this too, could be hormonal, but there is no clear evidence that could be located at this time.   And, for those who aren't aware, Parkinson's and Lewy Body Dementia are closely related, as PD is caused by the Lewy Bodies (Alpha-synuclein acids) destroying the cells responsible for dopamine in the substantia nigra portion of the brain.  LBD is caused when the bodies attack the cerebral cortex and other regions.

There is an interesting article, though on WebMD which discusses how hormone levels affect a woman's risk for developing PD or LBD.    It's truly worth the gander.

So, at this time I will be off.  I hope to continue seeking more answers as I'm growing more fascinated by this topic and I'm sure it will lead to even better information and topics.