Parkinson's and Lewy Body Dementia: Some Similarities and Differences

As I’ve stated, I attend a monthly support group in my area for Lewy Body Dementia.  Not only is it a great way to get out and meet people with similarities, but it also provides a great deal of information and support for all who attend.  Our leader lost her husband and is currently researching a book on the topic - which helps keep the group moving along with more knowledge being infused.   One of the questions the other day was, “How Does Parkinson’s Differ from Lewy Body Dementia, and How Are They Diagnosed Differently?”  A very good question and the response from the visiting neurologist gave some very good answers that made perfect sense.

Of course, PD and LBD are caused by the same misfolding of proteins and the onslaught of the Alpha-Synuclein Acids that affect the dopamine production and supply in the brain.  Remember, this cause is quite different from AD or most other dementias.   For the purpose of this post, I’m going to focus mainly on PD and LBD and their similarities and differences, in case anyone was really curious.

First of all, LBD (Lewy Body Dementia) and Parkinson’s Disease (PD) fall on the spectrum of dementias.  PD is at one end, and Alzheimer’s (AD)  is at the other.  LBD falls somewhere in the middle as it may contain symptoms of other dementias as well as Parkinsonisms.  

With Parkinson’s, the symptoms may begin small and over time (we’re talking quite a while in most cases) the tremors will begin affecting one side of the body.  The signs will gradually become noticeable to others - tremors, posture, walking, and facial expressions.  This is Stage One.

Stage Two will incorporate both sides of the body demonstrating tremors and stiffness. Walking and posture will be more affected and there may be more difficulty in dealing with Acts of Daily Living (ADL’s).  

Stage Three’s hallmarks (as this is considered “mid-disease”) are Loss of Balance and Slowness of Movement.  Falls are more commonplace during this phase.  While the patient is able to still conduct ADL’s, it is now more difficult.

Stage Four has the patient using aids for walking and movement and requires assistance in order to facilitate ADL’s.  This means the disease has become quite severe and this is readily apparent.

Stage Five happens when the patient is now no longer able to walk or care for themselves at all.  They may also develop hallucinations and delusions.  This is the most severe of all the stages.  (the above information is available at Parkinson.org).

Now, where does PD originate?  The same place as LBD.  The Spina Nigra where dopamine is produced.  The Alpha-Synuclein Acids begin to block the production and supply of the dopamine to the rest of the brain.  But, unlike LBD, it also begins in the Medula and the Olfactory Bulb and slowly works its way to the Cerebral Cortex.   Huh.  This is interesting.

With LBD, the bodies are present in the Spina Nigra and the Olfactory Bulb but are more present on the Cerebral Cortex and then work their way down and in.  So, in a sense, we have two diseases that, perhaps, work in opposite ways, while presenting themselves with similar symptoms.  

As I’ve already discussed ad bordomum (as though that’s a word) the symptoms of LBD, I’ll not go over that.  Just know the patients tend to show the same symptoms, but the dementia begins at an earlier stage, along with the hallucinations, delusions, and inability to carry out ADL’s.  

There is an interesting article, but for the purposes of this post, it addresses the differences/similarities between AD and PD.  You can find it at:  How Parkinson's Disease Affects Mental Ability.  

Now, how are they diagnosed to be different?  Well, that’s a question that really caught my ear.  Apparently, if you begin showing signs of PD and then within a specific range of time (one to two years - at most) dementia and the signs of LBD begin to demonstrate themselves, the diagnosis may change.  Interesting, non?!  

Anyhow, I hope I’ve done a little enlightening and piqued your interest a bit further.  It’s satisfying when I learn something new and can share it with others.  I hope you feel the same.  

The Week Ending 10/11/2015 - Or Just Enjoying the Plodding...

Was it a strange week?  No, not really.  Did Mom crash?  No.  Did she eat?  Why, yes, indeed - she ate nearly every meal for the past week.  Was she active?  Verbally - yes.  In fact, the log noted that she was involved in conversation quite frequently during the week;  Physically?  Nope - probably less than one full hour for the duration.  

Today, Mom was an odd duck.  Ledi  explained to me that she was in a very good mood.  I found her in the television viewing area just sitting and resting her eyes.  She was gladdened to see me and expressed this.  We began a chat as we would have normally.  All seemed well until I asked her where her watch was.  That began the downturn of the topic.  Apparently it was a trap.   She spoke in nonsequiturs of the trap that was set, and the watch was the root of it all.    I found this mildly amusing.

Next, she told me her mother was living in the basement but hadn’t seen her yet, today.  She inquired about whether or not I’d seen her.  Nope - she was off gallivanting around town with her friends.  “That sounds like her,” Mom replied.  

“Call Jean and have her come over.”

“Now?”

“Yes, now.”

“Well, she can’t.”

“Why not?”

“Today her children come by for visits and needing to drive over wouldn’t be very relaxing for her.”

“Well, so you say.”

And so I did.  

We continued to chat about this and that - I was surprised at how well Mom was recalling some things as well as speaking clearly and lucidly - her random spits of sentences had nearly vanished!

She didn’t want lunch, as she stated she’d already eaten it.  Then Reina heard mentioning it, so Mom said we needed to go as she was hungry.  Wow.  

We sat at the table drinking coffee and talking about the colored leaves on the trees in the garden.   Then her table buddy, Rosemary, came to sit down.

“You’re not going to let me drink out of your coffee cup?” Rosemary said with a twinkle in her eye.

“No, there’s nothing there, but I could get you a cup, if you’d like,” I replied.

Mom was indignant.  How rude could I possibly be!  There was no shame in what I had just said.  Well, I guess not…

Then, Mom saw her arch nemesis at another table.  “That woman is a bi+++!” she said contemptuously.  I was shocked, but not overly so.  Old Mom was back - even for a few seconds.   She continued to stare at the woman making remarks about her “ugliness” and “mean face”.  Honestly, they have nothing to do with each other - that episode was over and done eons ago.

Ledi told me about something that had happened two weeks ago, a day or two after Mom had been coming out of her room in her undies but had been easily taken back to get dressed.  One day she came out wearing her underwear and nothing else - she sat at the table for breakfast.  Ledi was shocked!  She ran  over and said, “Norma!  You need to go back to your room and let me dress you!  You can’t be like this out here!”

“I’m fine,” Mom retorted.  “I don’t like you.  Leave me alone!”

“No, Norma.  You need to be dressed.  Let me take you.”

“No.  I don’t like you and I won’t go with you!”

Then Morina came out and had nearly the same conversation with her.  Mom looked at Morina and told her she was mean and that she would go with Ledi to be dressed.  And off they went.

When Ledi tried to put Mom’s pants on, Mom grew angry.  Then Morina came in to check, and Mom looked at her and said, “I like her.  She can help me do this.  You go away, you nasty person!”  So, Morina helped her finish dressing.  After that, Mom was happy and content and didn’t recall anything.

Mom and Ledi share a moment

Mom has been bathing, thanks to Jennifer from Hospice.  Her clothes look good and clean, and she seems to be in radiant health.  

But that was only for my visit.  Before I saw her, Ledi told me Mom was mumbling and not really coherent when she sat down to visit with her earlier.  Not sure what that was about...but then LBD tends to be quite unpredictable!

And, we can also compare this with the visit of Connie and Jean earlier in the week:

Connie knocked on Norma's door just after noon. When she opened the door, she looked as if she had been asleep.  But as usual, she welcomed us in, and we all sat down.  Norma had her big chair, Connie had her walker seat, and Jean learned to be more definite in her chair placement.

Near the bathroom door was vetoed, as was the closet/sink area. Then Jean placed the folding chair to the left of Norma's chair, despite her protests.  Lesson learned: ignore negative comments and do what she wants to do.  We know you learned that long ago.

Connie gave Norma the booklet of new postage stamps, many colorful pictures of the latest issues. Norma paged through it, as the two exchanged comments on the pictures. Norma was wearing coordinated beige shirt and pants. Her hair always looks good, and we often tell her that.   Her Skechers were in  the little cupboard to the right of the sink. She took them out, one at a time and we admired them; they went back into the cupboard.

We encouraged Norma to go to the community room for lunch, but she was not interested. (Two hours later she was ready and ate all her meal.)  Norma brought out her large, leather (?) purse to take with her; we said it would not be needed. She seemed intent on taking it with her but then did not take it.

Finally we three sat at "our" table, the one nearest Norma's room.  Jean asked her if Jennifer from Providence had been there lately; no memory of that. And even mentions of her favorites, Lettie, and Morina, brought no recognition.  Bingo? We did not ask, as it would have been lost in the sands of time (24 hours or so).  But many of the old memories are there, and we are thankful that we can share those, even if it's just a positive comment. We enjoy sharing in having Tom and Lucile still alive in Norma's mind. We knew them, so can add to our appreciation for them--or anything else that fits the occasion.

Jean counted four times Norma expressed  a whole sentence or thought; Connie thought it was many more times.  She is probably more observant than Jean.  All our conversations were pleasant, and it was, as always, a truly enjoyable visit.  We all had coffee and were offered food, as Norma finally had her lunch. We each tell of our adventures, and Norma seems interested, remarking on this or that.

But we saw a real decline since our last visit two weeks earlier.  Even so, her real Norma attitudes and beliefs are there in phrases, if not complete sentences.  Her personality is there. She's a strong lady.

We have learned to give Norma a quick kiss and maybe a hug, and depart post haste. Connie got her walker from Norma's room, and we left her in  good spirits.

So, you can see, Mom is still somewhat vibrant - especially in her opinions and views, but also in her appreciation for her friends.  

It’s good to know that she’s plodding along well, now. As I’ve stated before, when the next shoe falls we’ll be able to look back on all this and smile.

Envrionment Risk Factors for Dementia: Part One

Part 2        Part 3

Scientists, doctors, and others of their ilk, have been pursuing the root causes of dementia for some time now.  They’ve made some interesting findings as well as predictions; however, for this post, we’ll begin delving into some of the interesting theories of what may be causing the increase of the disease/syndrome (there is actually debate as to whether or not dementia is a syndrome rather than disease, but that’s another day), so you might have some better information and more questions to ponder during your day.  

To define “Environment” seems to be another task.  In much of the literature written and available, the term can be that of the cellular and/or genetic environment of the subject.  While evidence suggests that for many there is a predisposition to dementia, and we may introduce the technical term later in the post (of which I’m not quite sure how many parts there will be, as I have discovered a small, yet vital, treasure trove of articles and excerpts that I will be scrutinizing and implementing) I heartily doubt it will appear as you may wish it today.

Environment, for the purposes of this post, will be anything that is in our daily lives - external of the body, for the most part.  Yes, That would be a nice way to put it; keeping a simple definition usually is best.  

Well, let’s see what we have first - Oh! Lead.

Lead is an element that used to be used in paint, and could also be present in other forms.  Exposure in the early years of life has been shown to lead to neurodegeneration in later life as this element can cross the blood-brain barrier and wreak havoc in the neuro-transmitters and create cognitive decline as well as other harmful symptoms.  In other words, it’s not a good thing.   Unfortunately, this and the following element, Aluminum, are both found readily in our daily lives and we are exposed whether we like it or not.

I remember as a child, sitting in my first and second grade classes being shown informational films on the dangers of lead paint.  I could never understand what this meant - I mean, I was young and they told of dangers of eating paint chips.  Really?!  Eat paint chips?  Who would do such a thing?  This was nothing I had ever considered until they told us not to do it.  I then began to wonder what would happen if I did!  I’m not sure I ever was able to locate these - but later it was explained that they tasted sweet, and the low-income children might have such exposure due to boredom, lack of education, and hunger.    Well, luckily they don’t have much of such a thing around any more.

Aluminum is another toxic element that is, actually, quite prevalent in our food, these days.   I recall when my grandmother was diagnosed with Alzheimer’s that this was a theory of causation.  While I considered it plausible, I wasn’t sure how we could eat with so many types of aluminum pans and pots and more people weren’t affected.  Well - guess what!  We ingest it regularly in more ways than you can imagine!   It is used to make water clear, in food dyes, to help salt pour more freely, and it also helps baked foods rise.  Now, ain’t that a kicker!  Did you know that there is a threshold as to how much you can ingest and not be affected?  Well, there is.  Most people don’t take in that much, but it also depends on your diet, as well.  They have found that a single serving of some pancakes contain 5 times the daily dosage of what was considered to be the threshold dosage attributed to old age memory loss - and if eaten chronically, this would, in turn, create such a dilemma for the subject.     Foods such as some baking powders, pancake/waffle mixes, frozen foods, and frozen waffles/pancakes contain the greatest amounts of aluminum - so, eaters beware! (environmental Factors in the Development of Dementia) 

Believe it or not, there was an experiment performed by injecting aluminum directly into the brain and they discovered it created plaques and tangles associated with Alzheimer’s! 
[NB - Studies in the 60's and 70's have debunked the Aluminum Theory, however, in combination with other elements, I believe there still could be cause for concern]

While these two elements are present - it’s the “over-ingestion” of them that does the damage.  I find it rather disturbing that the FDA hasn’t done anything about the levels in the food, and that more isn’t being done to educate parents and adults about the dangers of the exposures!  

While I didn’t go into great details about the actual effects of these elements, I will trust that you might wish to find more information at the following resources (See Also Part 2):

environmental Factors in the Development of Dementia

Environmental/nutritional risk factors

Alzheimer's & Dementia Risk Factors

Research into the causes of dementia  

Link between Aluminum and the Pathogenesis of Alzheimer's

Controversial Claims About the Causes of Alzheimer's …

Study: The Alzheimer's-Aluminum Direct Link

Lead Exposure & Alzheimer's Disease: Is There A Link?

Dementia Causes

Bolstering a Link Between Alzheimer's Disease and Lead ...

What's the Scoop on Dementia? Is it All Alzheimer's?

It seems odd, doesn’t it?  Nearly everything I’ve been reading on dementia has to do with Alzheimer’s.  It may have something to do with it afflicting more of the population, worldwide, than any other, but still.  

I remember years ago, about 1981 when Alzheimer’s was a new disease - there were so many people discussing it.  The reasons for their grandparents being a little “off” now had a name - and they went with it.  Books, movies, television shows, talk shows - the gamut - all featured speakers on this newly named affliction.  The research was beginning to produce some results and still no one knew what it was.  

Fast forward to where we are today and you still won’t be considered ‘out of the loop’ of you’ve not heard of any of the other types of dementia - Alzheimer’s is the favored topic.  It’s quite interesting to note that so many still associate any form of dementia with Alzheimer’s and will argue tooth and nail that they’re all just a different form of the same disease - even some caretakers!  What the ???????  But then, perhaps I’ve been enlightened because of circumstances in my life.

To the general population, dementia isn’t something demanding attention - No, it’s swept away and put into a figurative box with caution tape surrounding it.  It’s an inevitable truth for many, and the future numbers of those who will be diagnosed will increase dramatically over the next 35 years!  In fact, according to the article, Soaring dementia rates prompt call for global action, those numbers will skyrocket from approximately 35 million today to 155 by 2050 unless interventions are produced and put into place.  Think about that nugget for a moment.  The population is estimated to decline by approximately 37 million people during that time, as well.  What does that mean for you?

At this time, 1 in 8 people is touched by dementia.  If the population is at risk for developing the condition at such an alarming rate (due to genetics, the environment, and other factors) doesn’t this mean we should all be considering options?  What may lie in store for you or me?  Should one of us be stricken how would/could we handle this?

Some will consider suicide, others will doctor their wills to ensure their heirs will not inherit much if they’re put away in a home, and still others will find other options.  What would you do?  How will you handle your loved ones should they be afflicted?  Will you take the high road? Will you find reasonable options that help you and your loved one(s)?  

You might also be considering the different forms of dementia in order to begin weighing options.  Mom has a very good quality of life at this time; in fact, she is better off now than she would have been had she been brought into one of our homes.  She has round the clock care, a regular schedule, regular visitors, activities, room to walk and roam, and good meals with no conflict (unless, of course, she determines it’s warranted).   What would you do?

Yes, Alzheimer’s gets all the attention, but other forms such as Lewy Body Dementia, Parkinson’s Disease Dementia, Sundowner’s, and others are still being researched - although without  the funding given to their more prevalent relative.   

While there are funding avenues (Amazon Smile is one program in which a portion of your purchase is donated to a charity  or organization of your choice, and there are sites for the organizations such as LBDA.org, Alzheimers.org, among others) and you can help make the difference.

While interventions are coming out, they’re still experimental and no one is quite sure the outcomes.  There may be some ethical channels that also need to be navigated with some of these procedures, as well.   Stay tuned, as I may be investigating some of these in future posts.

Rolling Along and Enjoying Ourself...OR The Week Ending 10/04/2015

This has been, fortunately, a week of no great incident, no great decline, nothing novel to report on; just a nice autumn piece of time that can be enjoyed in the warmth of the October sun.  So, I write you to give you a brief synopsis of Mom's doings this week:

Monday:  Mom was up and about.  She wasn’t really wanting to do a great deal, but her activity level has certainly perked up, as has her mood (well, to most of us who know her, that is)!  

Tuesday:  Mom had her shower (Thanks to the hospice nurse) and then went outdoors with Morina.  They even took a walk!    As you can see in the photos, she is feeling spry and much better.  She has been eating quite well, for the most part, and it shows!  She even went to BINGO and enjoyed herself.

Wednesday:  Because life does happen, even with the best intentions, the RLC was unable to venture over to St. A’s because of some health complications with the driving member (the one who carries the car keys).  We’d rather she take care of her health than make the journey, disappointing as it may be.  

But, she did participate in the activities presented in the cottages, even if it was for a very brief (a few minutes) time, but - Hey! - she did it!

Thursday:  More activity dabbling and eating well.  Her perky and pert self was even in the mood for going outdoors more lately!  

Friday:  As with the other days - but she ate only two meals (breakfast and lunch) and refused her dinner - she said she just wasn’t hungry enough!    She had another shower!

Saturday:  BINGO and a little more activity.  

Sunday: Mother was in a bit of a mood when Leddy came to help her.  She refused her medications and simply wouldn’t cooperate!   She came out later for breakfast and just took her lovely time enjoying every morsel.  

I arrived when she was nearing completion of her meal.  She seemed rather alert.  One woman was sauntering behind us, and Mom quickly stated that some of the women who lived there “aren’t right in the head!”  I choked back a guffaw.  

It would appear that when Mom has a strong opinion on something the words come out well.  Otherwise, she searches high and low for what she’s going to say which then becomes a complete other thought - or two - or three - oh, the possibilities and outcomes are endless.  Needless to say, she’s not quite so articulate in most cases.  

So, after a brief visit, I was off to do some necessity shopping for her (but first, as I had the dogs in the car, we ran out to the Sandy River Delta and hiked for a bit.  The dogs - actually just Simon, the lab, Samson the peke-a-poo just went for the tan - went to the water and played with an impromptu pack of dogs in the water).  

Upon my return, I discovered my brother had been with Mom.  She had finished her yogurt from breakfast when he had arrived, giving him the perception she had eaten lunch - nope!  she hadn’t.  They had a most lovely visit in the gazebo for some time, then wandered about the garden.  I arrived as they were about to head inside; we spent more time in the garden, though.  Finally, Lawrence took his leave (he brought Mom some chocolate chip cookies his wife had baked for her) and, as Mom wanted to leave with him, told us to meet him around the front.  So, Mom and I toddled to the television room of the cottage and the idea of a front door vanished.  

We then walked back outside and had a very nice chat gazing at the birds and the tree (which were swarming with birds).  She was quite content.  

Finally, we went to her room where she began feasting on the cookies with a glass of juice, and I put on some soothing music for her.  She was in greater bliss.  She was beginning to nod off, so I took my leave.  

“I love you!” I said as I kissed her forehead.

“I know,” she replied.  

“Um, you’re supposed to say you love me back!”

“I suppose so,” she replied giving me the evil eye.  This made me laugh.  

Now, remember, the doctor said she might rebound once in hospice and this might last a couple or three months - but then there may be a big slide.  Fortunately, that adventure doesn’t seem to be winking in the wings, just yet.

Lewy Body Hallucinations - A Common Occurance for Many

Many months ago, I wrote about the differences between Delusions and Hallucinations.   Today, I’d like to review the topic of Hallucinations, once again, if I might.  

What is a Hallucination? A Hallucination is seeing something that no one else experiences - even smells.  It could be anything that appears real to the person experiencing the phenomenon, but has no bearing in actual reality to anyone else.    If a person were to see bugs or ants crawling up their arms and smothering them, and began to scream - this is because it’s a real sensation and visual to them - but to those around them (hopefully medical staff) it is something that is induced by drugs or some other compound that has entered into the person’s brain/psyche.

So it is with LBD.  

When Mom called me and was very upset, probably about 2 years ago, she told me she was in the living room trying to be safe while all these people came into the house.  She was crying in desperation.  She told me they were taking things and laughing at her.  She was horrified and mortified.  I asked her to hold the phone up so I could hear them (something seemed amiss about this happening), but there was nothing there.  She was upset that I remained so calm.    You see, for her the experience was quite real as it “occurred”.  For me, though, it was an event that was inexplicable  and made no sense.  

Now, Mom was in the diagnostic stage of LBD; I say this because we really hadn’t a clue as to what was going on - we just knew she was a great deal dottier than we’d ever seen her.  This was causing great concern.  According to Lewy Body Dementia via Helpguide.com, these may occur in the later stage of AD, while with LBD they can occur in the early, mid, and later stages of the malady.

One man who is caring for his wife, suffering from LBD, talks about how his wife is always seeing cats.  She sees them in the corner, next to her, in her lap - just about everywhere.  He explains that he needs to be quite careful not to step on them, so he watches his wife’s eyes carefully.  He has found this to be a very charming hallucination and they are able to enjoy it - although he hasn’t the ability to actually experience them as she does.  

But what causes these hallucinations?  Good question.  It took some digging, but I believe I was able to find something that imitates a good response.  According to the article, Parkinsonsim and Related Disorders (Rabey, Josè Martin. "Hallucinations and psychosis in Parkinson's disease." Parkinsonism & related disorders 15 (2009): S105-S110.) there is a defect in the production of dopamine on the brain, which enables the brain to begin produce psychotic effects that are more coping than helping.  

While Seroquel (Quetiapine) has truly helped Mom, it is truly something that needs to be monitored closely (she is on a relatively low dosage).  Mom hasn’t had any hallucinations for quite some time, now, and is happily dispensing stories based on delusions, instead.  Yes, Delusions.  Remember, there is a rather big difference between the two.

Okay, so back to hallucinations - LBD patients, and Parkinson’s patients aren’t the only ones to suffer from such a symptom.  No, remember I mentioned above that AD patients suffer in the later stages from this affliction.  Perhaps it takes longer for the tau proteins and beta amyloid plaques to affect the brain (as they do work so differently from the Lewy bodies), that they reach that part of the brain much later.  

Anyhow, that’s all I have to share for today.  I hope it has given you a little more information, or at least bitten you to do a tad more research yourself.  

Below is a video posted by a daughter who is showing her father having both hallucinations and delusions.  To be honest, this is a bit (not completely) what it is like with Mom.  It may seem sad, but it gives a great deal more illustration and reality to the phenomenon.  In fact, this poor man has less mobility than Mom - it's the conversation that is quite similar (although Mom is a bit easier to understand, as well).

What Is Spectrum Dementia, and What Are the Differences?

What is a spectrum disease?  It’s a mental disorder that includes a range of linked conditions, sometimes also extending to include singular symptoms and traits (Spectrum disorder).    This usually pertains to Autism, but it also refers to Dementia, as well.  

According to the information from the Lewy Body Dementia Association, and the below lecture (sound is awful, but the information is incredible), there is a spectrum of dementia - at one end is Alzheimer’s (AD) and the other end is Parkinson’s Disease (PD).  Lewy Body Dementia falls somewhere in the middle, but there is no definitive point at where it might occur on that line.  

You see, LBD and PD stem from the same cause - alpha-synuclein acids in the brain.  PD is caused by the prevalence in the motor control portion and LBD has the little demons mostly surrounding the cerebral cortex, as well as other portion.   AD is caused by Beta Amyloid plaques in the brain.  AD is so very different from LBD/PD, and yet there is the phenomenon of mixed dementias - in which the LBD patient may have some of the same plaques and tangles of the AD patient, and the AD patient may develop some of the same symptoms as the other.  It’s a rather tangled and confusing issue.

There have been studies performed on locating just where on the spectrum LBD might be found, but they haven’t been able to make any determination (Ballard, C et al. "Differences in neuropathologic characteristics across the Lewy body dementia spectrum." Neurology 67.11 (2006): 1931-1934.).  

Now, the LBDA (Lewy Body Dementia Assn) expresses that the disease (some also state this is more a syndrome than a simple disease) runs a great spectrum of disorders that come together into the form of dementia which has found its way into our lives (The LBD Spectrum).  There is also a good article that does a much better job of articulating in few words than I at Alzheimer's Disease: One Type of Dementia on a Wider ….  While the end is a promotion, you can take the rest into account.

Following is a video which demonstrates (I may have posted it many moons earlier) the differences on the brain of PD, LBD, and AD.  As I stated, the sound is rather horrible, but the information is very intriguing, and I find myself watching it from time to time and learning much more:

This does such a fantastic job of showing the SPECT and PET scans, which are so expensive, that you are able to see the differences of the plighted brains.  There is a great deal of differences between the two ends of the "spectrum" and with LBD, as well. 

I hope I've been able to shed some more light on the topic, for those who might still have questions. 

The Week Ending 09/27/2015

Could it be the Harvest Moon and the Eclipse?  Could it be just the odd way that LBD conducts itself?  It’s difficult to know.  This week proved to be like most others - somewhat uneventful, and yet, there were some noticeable nuances that occurred. 

On Monday, Mom ate well, she was active in her conversations, but she refused to participate in anything else. 

Tuesday brought the hospice nurse, Jennifer, who had been advised by Leddy as to how to get Mom to respond and listen to her when taking her in for her bath.  She’s direct and doesn’t allow Mom to engage her.  Perfect! 
Mom arose late but ate breakfast and then dabbled in her other meals - so all-in-all, she ate two meals, which is par for the course.   Mom still did a little conversation exercise, but not for very long. 
Her massage therapist came by twice to engage Mom, but Mother was too engaged in listening to other conversations and dabbling with her food to care - hence, Alli, the therapist, left and called to let me know that she would be glad as a reference, but wasn’t going to make any further attempts as Mom hadn’t been interested for the past 3 weeks.

My cousin (whose mother is in another facility in Portland with LBD) called me in the morning to ask if it would be okay to meet her, her mother, cousin Janet, and Aunt Keiko (my late uncle’s widow) at Janet’s in the early afternoon.  I had to remind her that Mom couldn’t go out anymore, and that I would have needed at least a day’s notice for such an event, anyhow.  This was difficult as I know Mom would love to see Keiko and Alice (my cousin’s mom), but it just wouldn’t have been feasible with my work.

Wednesday, Mom arose rather late and was visited upon by her RLC, Connie & Jean.  Following is their experience: 

Dear Tony,

We arrived at St. A's a bit before noon.  Norma was lying on her bed, dressed, no shoes yet.

Noelle the nurse was there, after checking her blood pressure and whatever else she checks.   She said everything was in good order and left after a few minutes.

Norma seemed glad to see us, and she looked good. Was wearing that beautiful white sweater and beige/tan slacks.  She sat up so I could put on her shoes and those DIRTY once-white sox.

I offered to get some clean sox from her dresser, but "Those aren't dirty!" was her protest. The shoes went on, with Norma and Jean working together on that.

We chatted along with Norma; she was involved with our conversation, adding thoughtful words, phrases that started out with an idea that could not be completed.  At one point, when this happened, she said quietly, "I'm goofy."  But it was stated as fact, no anger or frustration evident. We just continue when that happens; always something to talk about.

A quick trip to the bathroom for Norma, then we all went to the great room. I urged the others to hustle, saying, "Our table is empty now." That's the table closest to her room.

Amparo greeted us joyfully; she always does. She brought soup for Norma and Connie; Jean was not interested. But the friends ate all of theirs.  We all had apple juice.

Norma's lunch was soup, half a toasted cheese sandwich, few slices of apples, about a dozen big grapes.  She insisted that Connie and I share the grapes, even after Jean told they are full of Vitamin C, good for her. She ate her lunch readily, and we ALL had berry pie for dessert.
Norma asked if we take off the heavy crust at one end of the pie.  Yes, we do. We  took those off, and she offered Jean hers, in case she wanted to eat any pie filling left on it. Regretfully, Jean said No, thanks.
(When she has a drink she does not care to finish, she says to  Connie and Jean in turn, "You drink it." )

It was a comfortable, no-problem visit, just old friends chatting about anything and everything we think of.  Norma's comments, not often completed, are at times thoughts on how someone "should/should not do something,"  and observations on people's motives and habits. She's observant and sometimes makes moral judgments.  (Don't we all?)

Norma mentioned that Pat McEntee was not "doing well."  No, he's not, did not recognize me again today.  Jean commented that she’d heard Pat has a heart condition.  Of course, your mom knows it's more than that; she notices, but we went on to another subject.

We were so comfortable sitting there, looking out at the garden, but none of us had the ambition to actually step outside to enjoy the sights and air.  It was suggested but did not press.

Jennifer, the CNA who comes twice a week, stopped for a few minutes' visit. We met her when she first came to see Norma--in the garden.

After 2 pm we said it was time for us to leave.  "I'll go with you."  Jean told her we can plan ahead
for some other time (was that not wise?) but today Jean had visitors coming, and lots to do after that.  Jean quickly kissed her forehead and walked to the exit.  jean motioned to Connie to follow; had forgotten her walker was in Norma's room. But she got moving and came soon after her buddy.

We are treated like royalty by the caregivers, which we appreciate.  Norma was engaged (is that the word?) during our whole visit. 

Thursday, Mom had a day of breakfast and lunch but no dinner.  She did participate in the singing exercise and the conversation, as well, but nothing else. 

Friday, Mom ate breakfast and lunch.  She participated in bowling!  Now, go figure that one!  Yes, they have something set up for the residents to do a bowling activity that they all enjoy.  Later, Morina and Mom engaged in a nice conversation.

Saturday, Mom ate breakfast and dinner.  She arose so late that there was no reason for her to be hungry for lunch. 

However, when she decided to get up (long after Leddy had come in and offered to help her but was refused) she came out into the dining room in her underwear demanding Leddy!  Other staff offered to help, but Mom refused.  Then Leddy came in and ordered Mom to her room, which she gladly obeyed.  Thank goodness - I’d hate to think my mother was one of those people!

Later that day, she participated in BINGO!  She truly enjoyed that.

Sunday, her arousal was much the same as Saturday.  Yes, she decided to tantalize the other residents in her undergarb.  Same scenario.  Gack! 

She ate a good breakfast and was in a pensive mood. 

I arrived and she looked at me.

“What are you doing here?”
“I came to visit you.”
“Oh?  Why?”
“Don’t you want visitors?”
“Suit yourself.  You’re a big boy.”

From there, we talked about many things - I’m not sure we were on the same wave-length, but we covered a lot of bases. 

At one point, I pulled out my camera and asked her to smile for me.  She stared at me as I encouraged her to smile.  Finally, she stated, flatly, “No!”  and then went about reading her paper.

I asked her about BINGO and she told me I was being inappropriate and that this was a very personal question.   Not sure about that….

She opened her paper and began to read - erratically, as she was more engaged in the conversation at the table next to ours (Pat and Lucille’s children had come by and were conversing with their parents). 

The lead story was one of a man who had a sad climbing experience in the Himalayas, so I asked Mom if she had seen the mountain range while in Tibet.  “Yes, but they were at a distance, and they looked big.” 

She did begin to tell me that she had seen many people last night at a dinner that was about autism.  I had no inkling as to where that came from until I saw the story on the next page of the paper - it had to do with autism.   Apparently, though, many of us were there and she stayed up quite late which was why she was so tired. 

Eventually, I gave her a kiss (she asked to leave with me) and I left.  My brother followed my visit with one within minutes of my departure.  So, she had a stimulating morning. 

With him, she chatted and they went to the garden after she finished her paper. 

All in all, it would seem Mom is doing fine.  She has good days and bad ones.  I prefer the good at this point.    Hospice is helping a great deal, and, perhaps, this is one reason she is "shining" at this time - who knows?  I know the bad will come in a flash, so it’s important to encourage and delight in these - albeit they are not incredible - as they come.