Alcohol Related Dementia, Malnourishment, and Medication Interactions: How they Affect the Brain

good morning everyone it's 11 o'clock and i want to get started because we do have a lot of information to cover um over the next hour talking about alcohol related dementia malnourishment vitamin deficiency medication interactions chris valdjeca disease there's several other things we're going to discuss in this hour that's not on this initial slide here but thank you all for being here i'm jamie with the james west center and my colleague holly is with us today as well i want to get through the content and make sure and leave a few minutes at the end to answer any questions that might pop up as well but also feel free to um chat in any questions that you may have or experiences or if you unmute and just say hey jamie stop stop stop i have a question about something or i want to share something please feel free to do that as well we are recording today's program and this afternoon i will send out a follow-up email with a copy of the recording a copy of the slides um and a link to an evaluation so we are offering one hour of free ce credits for nursing social work and licensed professional counselors so when you get your email today there will be a link for an evaluation when you complete that evaluation then within the next several weeks we'll get you your ce certificate out to you and there will be instructions in the email about time frames for the ce credits but please take advantage of those if you are able to the james l west center if you're not familiar we are a non-profit organization that serves persons impacted by dementia so those are persons living with the disease there are residential and respite care in our day program care that we are very ferociously working at getting back open due to covid and through our caregiver education through working with caregivers family and lay caregivers and professional caregivers as well and of course the community at large today's program are outlined for our ce credits and we are going to describe the common signs and symptoms again of alcohol and drug related dementias medication interactions malnourishment vitamin deficiencies and crew spelled jacob disease we'll talk about risk factors for each one of those as well as understanding the effects these conditions can have on the brain particularly when they're not managed well and then we'll um discuss some common treatment options for each one of those conditions so it will be a lot of content and some of the slides i'll go through fairly quickly but again you'll get a copy of these slides this afternoon for you to follow up on talking about age-related changes so starting off with some medication interactions because our bodies and our brains do change as we get older our older brains change in structure and our ability now i want to clarify anything for anybody particularly with dementia and memory loss memory loss and dementia is not a normal part of age what is normal about aging particularly when it comes to the brain is it slows down a little bit but when we're losing memories or having cognitive really bad issues that is not a normal part of aging so understanding that and we have other programs about what do you do when things are normal or excuse me are not normal um that can get a proper diagnosis and starting down that process but but know that are there things that change your brain gets a little bit slower okay our weight as we get older also can affect um how medications interact with our body so it can be whether we're overweight or underweight it really will affect how much a medication will stay in our system depending on our weight but also included in that is our digestive and circulatory systems the kidneys and the livers how the medicine processes through our bodies um it can medications can enter our bodies and how they leave our bodies how fast they're metabolized within our system or how slow they're metabolized within our system so they can stay longer in our systems as we get older just because of the circulatory and kidney systems are slowing down as well like the brain systems are the statistic here is 80 percent of older adults have at least one chronic condition and half of older adults have at least two so most older adults and that's an older adult is 65 plus is living with at least one chronic condition and when we have at least one chronic condition you know they're taking at least one medication if not several medications and the complications of those medications and the effects of the medications and medication interactions can really interact in um in negative ways for persons with excuse me for older people particularly in brain what they typically see is when you have interactions and medications or side effects and medications what it typically looks like are the symptoms of dementia so you see more confusion you see more memory issues you can see more changes in personality or judgment so those same symptoms that you see in somebody with dementia are commonly the same symptoms you'll see in somebody that's having some medication interactions within their system and so it says here are many of these side effects particularly in the older older population is can be mistaken as dementia so we want to make sure that we're getting treated for the right things right there are certain groups of medications that do affect older older adults cognition and these are groups of medications that have been identified that can affect an older person's cognition and i will say there are certain medications within these groups so there are certain antihistamines that have been shown that can affect an older adult's cognition certain anti-anxiety and antidepressants certain sleep aids antipsychotics certain muscle relaxants medications used for urinary incontinence or your bladder problems and anti-spasmatics some of those medications certain ones those medications are shown that can really affect an older person's cognition so this is memory the cognitive decline as well so really talking to a trusted doctor or another healthcare professional and this can be a social worker it can be a pharmacist about prescription use that's prescribed by doctors but also anything that somebody's taking that's over the counter because what happens a lot is an older adult has their prescribed medications and they might have one or two but they also might have eight or ten prescribed medications that they're taking but then they also have medication they prescribe themselves so all these over-the-counter medications that they're taking whether it's a low-dose bear or it's supplements or it's vitamins or it's herbal things that they've decided to add to their medication regiment that can interfere with the prescribed medications and whether that's negate the effectiveness of those prescribed medications or has a negative interaction with them so really talking to those healthcare professionals if any of those groups of medications are prescribed but also as an older adult and advocating for older adults and educating them really letting them know that they have to tell their doctors and pharmacists and other healthcare professionals all the medications that they're taking regularly so we have an understanding of what could be going on with somebody and the beers criteria this is from the american geriatrics society that's ags american geriatrics society this is a list of medications that doctors nurses pharmacists you name it have put together that really they recommend that are not safe or not appropriate for older adults this is not the beer's criteria doesn't have an exhaustive list and it's been around for um for several several years but it was most recently updated in 2019 so for those of you that might be familiar with it there were quite a few updates that were made not too long ago and and now here are these five things listed um they're really there there are medications that have been shown have evidence that suggests they should not be used for an older adult and neither it's avoided by most older adults and i like how they specified outside of an older adult that's not on hospice or palliative care settings needs to be avoided by people with specific health conditions but also avoided in combination with other treatments and risk for the drug drug interactions should be used with caution or avoided or try other alternative treatments because of potential side effects of these certain medications or dosed differently particularly if they have kidney conditions or even liver conditions it will pro impact how the medicine is processed throughout the body so there's that virus criterion you can just google that and it comes up with that it's a pretty exhaustive list but having that or at least having that for older adults to look through so as we're talking about medication and we're going to talk about some more drugs and alcohol use because really our being aware of the medications and how they affect the brain but affect the whole body but alcohol and drugs as well alcohol abuse is unfortunately pretty common among older adults it says 8 percent have a serious drinking problem but 60 report drinking regularly and five to ten report binge drinking and you know are those numbers skewed how many people are really reporting honestly i don't know um but alcohol-related brain damage they're suggesting can account for up to 10 percent of dementia in persons under 65. so we are seeing more people diagnosed that are under 65 and we're seeing um unfortunately some of that is alcohol-related dementia and we're talking about binge drinking or heavy alcohol use for just drug-related or alcohol-related dementias and binge drinking is five or more alcoholic drinks or for men four for females at the same time or within a couple of hours of each other and they're doing at least one day in the past month so it's you know a month goes by and i'm having a bunch of drinks at one time heavy alcohol use is binge drinking five or more days in the past month so i'm doing that binge drinking at least five times during the month so understanding what that is as we talk more but alcohol kills brain cells um and causes severe damage to your brain so the picture here is a normal 43 year old and somebody who has alcoholism so they've abused alcohol for a really long time and you can just see the drastic difference there in those pictures so not only is it shrinking parts of your brain but you know there's also the other things that come along with alcohol abuse which is blurred vision slurred speech poor judgment poor decision making memory loss because of the damage that's happening to the brain they're also showing that persons with alcoholism or that have severe heavy alcohol use and binge drinking have a smaller hippocampus and the hippocampus is that part of our brain that is our learning center so it helps us take in all the information from a day helps us process it record it for us to learn new things it's that short-term memory center so persons with dementia excuse me persons with alcohol dementia related dementia um are having that smaller hippocampus the hippocampus is also the part of the brain somebody with alzheimer's disease that's the part of the brain that gets attacked first as well so you'll see the symptoms being about the same that that poor judgment poor decision-making memory loss but alcohol-related disorders or alcohol-related dementias are caused by chronic heavy drinking so this is years of heavy drinking the damage is related directly to the exposure of drugs and alcohol and the cdc reported about 17 percent of the adult population report binge drinking and six percent report heavy drinking again are those are we reporting correctly i don't know but particularly with um the effects of the pandemic that came up we have seen um the use of the sales of alcohol go up and the prescriptions for antidepressants and anti-anxiety medications are up by 35 34 and you can see the cells are up in alcohol 41 in women 54 in men and i would venture to say that those percentages have not gone down but alcohol-induced dementia can be acquired if one gets intoxicated with alcohol regularly again it's that chronic heavy use of alcohol and what's happening is the intoxica toxication depletes the nutrients in the body so not only is there serious damage happening to the brain but there's also serious damage happening to our organs our kidneys our pancreas and more so it's just toxic for the body overall in the study in the lancet public health journal this was done from 2008 to 2013 reported that alcohol abuse is the most significant prevalent factor in a dementia diagnosis they also one of the co-authors also said it's an especially important for those type for those with types of dementia that are start before age 65 so we do see more alcohol related diminishes or disorder to people that are under the age 65 but also knowing that people that older population does consume quite a bit of alcohol too alcohol really prevents our neurons from regenerating and from making strong connections and working well so if their neuron is not able to regenerate or make connections with other neurons throughout the brain it can't work and when it can't work it dies and it withers away so while anybody can really struggle with alcohol um this this condition is becoming more common in middle age and older adults and we talked about the heavy drinking and the binge drinking but the national institute on alcohol abuse and alcoholism defines heavy drinking as four drinks a day for women and five for men so in the alcohol um it again has the neurons or stops the neurons from regenerating and connecting and the neurons die so it has a neurotoxic effect to the brain and can really cause structural damage which we saw in the picture as well but the brain is not able to function like it used to it also is a major risk factor for other brain disorders such as epilepsy traumatic brain injuries it can also lead to or be a contributing factor to other dementias as well it also gives us high blood pressure high cholesterol irregular heartbeats it can increase our risk for strokes and is also associated again with a vascular dementia the other thing that happens when we tend to drink or abuse alcohol is we also start to do other um negative things or another other negative habits that contribute to poor health so when people are drinking heavily or drinking regularly you also see a higher right of people that are smoking a higher rate of depression and other addictive [Music] things that go on in life or other addictive choices also you do see it's not on here but poor eating habits people that don't exercise as much and then and then sleep is also hindered by alcohol so alcohol stops the brain from going into circadian rhythm that really helps us get good quality sleep so you're also not getting the right sleep the brain needs to be able to work effectively so risk factors for alcohol heavy alcohol abuse you don't need to be a binge drinker to increase your risk for developing dementia what many studies have said over and over again and diets have said is to limit your drinking recommended limit is 14 drinks at a a week at a maximum of two drinks a day what why what we're typically hearing is that um for alcohol for a normal use or it should be a healthy use of alcohol i should say it's one drink for women and two drinks for men per day and when i say a drink that's the ounces it's six to eight ounces of either it's wine or beer or a liquor it's that six to eight ounces it's not that the whole bottle and then of course um the drinking particularly binge drinking or heavy alcohol use also increases our risk of other use of using other lifestyle choices like tobacco that increases your risk for dementia so more symptoms that you will see of course memory problems language impairment you have the slurred speech but you also have language impairment and inability to perform tasks or complex motor tests like dressing driving would also be another one um you can also see people might have nerve damage in their extremities like their hands or their feet it's called peripheral neuropathy and this is because of some of the damage that's happened to the brain the cerebellum that controls coordination you can have tingling or numbness in those but you can also see coordination um and just their own study on their feet not able to again to do those motor tests like they used to or shouldn't be able to if they weren't abusing alcohol at higher risk for falls again because that cerebellum is being affected by the alcohol and with falls you're at an increased risk to hit your head and then have a brain injury of some sort so you can see a decline in cognition because of that alcohol also again damages the heart the liver the kidneys the pancreas so you can see some other conditions come up because of the damage happening to those organs and you do commonly see abnormalities of course in the liver or the heart and it's called alcoholic cardiomyopathy and this is the damage to the heart into the lungs that cause brain that cause additional brain complications and a much higher risk for strokes because you have low blood flow to the brain and then also alcohol along with all the physical effects that it does throughout your whole body you can have some psychiatric problems with alcohol as well and these are associated can be associated with with dementia and you can see some of these symptoms occur before you see any cognitive or memory or intellectual loss is in persons that have an alcohol related dementia you might see some of these psychiatric problems first before you see any cognitive problems and this can be depression or apathy higher anxiety irritability any psychosis but resistive to care or help from others and personality changes this can be seen as impulsive or hostile behavior that can re i mean it's impulsive and hostile behavior that requires medication um and then it can also the how the neurons are affected generally is it's the frontal lobe that's affected a lot and of course that cerebellum so you're more prone to injury because your coordination and movement is off but the frontal lobe houses a lot of our judgment and our impulse control so if we're not if this part of the brain is being damaged i might be using really poor judgment and i might not be as in control of my impulses or my emotions so that can i can have really poor decisions really poor judgments on things and more prone to injury so like dimension i'm gonna kind of veer off into this warning of course the cough because this can be a part of an alcohol related or it is an alcohol related dementia but it goes into because it's heavy alcohol use the body is not getting enough vitamins certain vitamins that it needs or nutrients that it needs as well so this is alcohol-related dementia is a broad term and the warnicky corsica syndrome is can be an effect of an alcohol related dementia the warnicky course of cough syndrome is a more specific condition um because it is a thymine deficiency and thiamine is a b12 or b1 deficiency the alcohol is not letting the body get any vitamins b100 b12 it is the most prevalent form of an alcohol related dementia and what it is is it's wernicke's encephalopathy encephalopathy i'll say it in a second of course it causes dementia the body the alcohol is preventing the body from properly processing this thymine that it absolutely needs so the encephalopathy is the deficiency that's come because you're not getting the thymine because the alcohol is not letting it but also excessive drinking because you might be vomiting or um avoiding in other ways as well so the body just can't keep it in its system either it's not going to process it but it's also not going to keep it in so you're depleted and deficient in it thiamine the vitamin the b12 vitamin vitamin is really helps our brain with the glucose that it needs to really be able to option up function optimally our brain has to have some sugar and glucose it really needs about 70 percent of glucose that enters into our body for it to function so if we're not getting that enough of it or getting it at all then our brain isn't going to be able to function and you can see that it looks like a lot of loss of coordination or stumbling unsteady on your feet you can also have abnormal eye movements um back and forth and then just confusion a general confusion because you're not getting that stuff when that is left untreated what happens is the corsical syndrome sets in and corso costs dementia and this is directly related to the severity of the alcohol and the for the damage it has on the neurons in the brain which leads to dementia so you will see the symptoms that are related to language difficulties memory loss confusion depression and any other cognitive conditions that you might see so let's watch this short um video which will explain the cornicke's worst warnicky syndrome a little bit better another neurological disorder affecting memory is corsical syndrome which is caused by a lack of vitamin b1 or thiamine in the brain this disorder is strongly linked to severe malnutrition eating disorders or especially alcoholism because these groups often don't ingest or are unable to process all the nutrients their bodies need including thiamine thymine is important because it's responsible for converting carbohydrates into the glucose your cells need for energy and it's especially important for the normal functioning of your neurons at first a person developing korsakoff syndrome might have damage to certain parts of the brain resulting in poor imbalance abnormal eye movements mild confusion and or memory loss at this stage it's actually called wernicke's encephalopathy which is the precursor to korsakoff syndrome if wernicke's encephalopathy is diagnosed in time then it's possible to reverse the damage or at least prevent more of it if untreated however the disease will progress into full-blown corsical syndrome the main symptom of corset cough syndrome is severe memory loss and this symptom is often accompanied by confabulation which is when the patient makes up stories sometimes to fill in the gaps in his or her memory unlike a.d korsakoff syndrome is not necessarily progressive if diagnosed and treated people can get better people are often treated with thiamine injections or other medication and they have to stay on a healthy diet and abstain from alcohol and some people may also need to relearn some things the effectiveness of this treatment really depends on how early the disease is diagnosed and how well the patient follows the treatment guidelines so that is a great explanation of warnicky corsa cost syndrome but also helps us lead into how effect or how damaging alcohol can be um to our system especially when left unchecked um and really how it really affects our brain now other possible causes of warner key corsica syndrome because it's again it's that deficiency in the vitamin the thymine um you can have a loss of vitamins from renal dialysis if you have some metabolic illness as well or you have malabsorption due to other conditions like anorexia and iv feeding people that are fasting maybe in an unhealthy manner or not being under a doctor potentially or any gi surgery that is and they're just not managing the treatment or the recovery of that well because the body's not getting the famine that it needs or other possible vitamins that it needs for the body to the bodies the cells and the neurons in the brain to optimize to optimally work in the way it needs to so to get a diagnosis of this it does require just with any type of dementia it's kind of a ruling out process and it requires careful clinical history and physical examination usually a group of doctors working together or interdisciplinary team working together it resembles other type the alcohol-induced dementia resembles other types of dementia so it cannot be confirmed with a simple clinical history there's a like i mentioned a kind of ruling out process um what it can be it is under diagnosed as well because remember i mentioned it's typically people that are under 65 it's the most common that you see that but we also when you see it in elder patients or the older populations here it says is doctors don't recognize alcoholism in the majority of elderly patients and then there is that whole attitude of well just let granny have her drinks what's the harm what we're going to do well there is a lot of harm if it's too many drinks there's a lot of harm for granny so being an advocate about that and also changes that are happening with alcohol abuse or alcohol-induced dementia can be non-specific or they can be very um ambiguous and it is generally thought as intellectual loss or maybe it's just a normal part of getting older but really having to look at the whole person and what's going on and there are brain imaging that can help but neuropsychological testing that can help as well and being honest with behaviors and what you see again treatment for this sobriety is the number one treatment which means that um and like i mentioned in the video it doesn't have to be a neurodegenerative or progressive disease it can stop um and get better or it can stop and maintain where you're at depending on if you're getting the right vitamins and nutrients into your body you're not you're abstaining from alcohol any management of other conditions that might have happened whether it was due to kidney attacks or liver failure or something like that and being a close watch on your heart too but it says here long periods of pro of sobriety for patients with alcohol induced dementia can result in small and slow improvements over time and some patients will stabilize after a while so it's well established that alcohol use disorders damage overall health and overall well-being and can contribute to a shorter life expectancy by more than 20 years but with treatment and recovery many of the ill effects of the alcohol abuse are diminished and patients can see a significant boost in their physical and mental health so it's important to get this diagnosed and get into trust as soon as you possibly can but talking more about malnutrition and vitamin deficiency because we know just with the corsicops or the thymine deficiency how that really can affect the brain so can other deficiencies in vitamins and we're just not having so we're having some malnutrition and malnutrition is really and vitamin deficiency is defined as a person's diet does not provide enough nutrients or the right balance of nutrients for optimal health and this affects all groups of people nine million older adults can't afford nutritious food one in four adults 65 and older either skip mills or reduce milk sizes or they're giving half of their meal to their pet up to 60 percent of older adults in health care settings are malnourished and 16 of independent older adults are at high risk for malnutrition for various reasons it also affects all sizes and this is important to note too because you can be malnourished and be overweight and be malnourished and be underweight it says about one in three adults 65 plus are overweight and malnourished and about 715 000 adults 65 and plus are underweight and malnourished so risk factors for this the malnourishment and when we're malnourished for not getting the vitamins that the body needs um can be reduced into food intake due to mental health because they're not can be early signs of dementia they're not remembering that they already ate or recognizing that they need to eat um they just have a poor appetite uh mobility problems hard to get make the food and get the meal and go to the grocery store and it takes a lot of energy to do that other chronic conditions that can for a variety of reasons have poor appetite limited income living alone and isolation the side effects of medication can cause poor appetite or anything like that or just feeling ill overall and not wanting to eat depression dementia fad diets fad diets can sometimes what the fad diet is is they restrict a certain nutrient um that your body may need so you can become deficient depending on what that diet is restricting any gastrointest intestinal disorders you're eating too much of fat too much sodium too much sugar so the body's not getting other vitamins or nutrients that it needs or your body is just having a hard time absorbing nutrients you might have something else going on poor dental health so it hurts to eat and then trouble with swallowing or chewing any other digestive orders of course alcoholism or if you have a nutrient loss due to other ways to void whether we're vomiting and we have a dialysis or diarrhea that's not being managed or treated so it's just the body's being depleted of those nutrients through those through those ways how you also see malnourishment and the effects on on the body is as we age our bodies we naturally lose some muscle tone and bone density but malnourishment accelerates those losses so it really impacts our independence and our autonomy if we're malnourished because may not be as mobile i may not have great posture i may um have more falls and may not have as much strength and if i fall and break something i'm going to have a much harder time to recover from that or go back to the way i was before and then the healing and the immune system being malnourished a lack of nutrition excuse me nutrients in our body really decreases our white blood cell count and really makes it harder for our body to heal and but also fight off infections and illness other things that it does to our organs um it harms our eyes our body our eyes needs need of vitamins and it can increase our risk for glaucoma or cataracts or macular degeneration a lack of fluids and electrolytes cause our kidneys to overwork can lead to dehydration pretty quickly joint pain and heart disease you'll see this the skin change it can change color you can see changes in your nails they become brittle excuse me they have more ridges in them those are signs of malnourishment or they become spoon shaped lots of hair you can notice an increase in irritability or depression anxiety and then you also see with the malnourishment or the deficiencies of nutrients how it affects the brain because you can have loss of speech some language difficulties poor coordination poor memory or memory loss lack of concentration more confused more disoriented and then an increase in apathy so to prevent or treat malnourishment adjust your diet to make smart food choices and this can be talking to your doctor maybe getting a referral to a diet dietitian to really what your body needs your body needs all nutrients it may not be an increase in food but it might be an increase in certain foods that has the nutrients there's the choosemyplate.gov which i'll show you an example of here in a second that includes all the food groups and the body needs and hydrate increase your water intake maybe decrease the alcohol or decrease the caffeine intake and really drink more water water is a nutrient and it's an important nutrient our body is mostly water so we need water to optimize to function optimally talk to doctors about possible side effects for medication that can make a poor or cause a poor appetite or maybe make our body harder to absorb certain certain vitamins and exercise you know exercise this helps build that muscle strength it helps um our heart health that bone density and helps us keep our balance up and feel more confident on our own two feet as well and then making sure you have good dental care taking care of your mouth and your teeth overall oral health really can have a positive and negative impact on your life but it can lead to gum disease it can lead to other dental problems to where it really does affect your your food intake and your ability to eat well or eat certain foods that are vital to your good nutrition so this is an example of the choosemyplate.gov so it has on here fruits focus on fruits and there's a variety of them vegetables of course a variety of vegetables eat more dark leafy greens more orange vegetables or beans on here it also has physical activity this is part of your diet is physical activity and a balance between food and physical activity oil so knowing your fats and how we cook our food is important so most of your fat sources from fish are going to be your healthy fats or from vegetable oils or things like that or nuts and we want to limit the fats the solid fats so if it's a solid like a butter or a margarine or lard we want to limit those or get rid of them all together and use more healthier fats milk can be calcium rich it helps with that bone density so choosing good you know low fat or fat-free milk or if you're lactose intolerant there are a variety of other options out there but have different types of milk that have a lot of calcium in them and then grains and this is saying make at least half of your grains whole so it's a whole grain so it's the um it's the whole brown rice it's the quinoa it's the um the orzo it's you know it's looking for the word whole before the name so it's whole pasta whole grain that you want to see because if it's not whole that means it's been processed and the processing takes the nutrients out of the grain and what we want is the nutrient so we want to keep the whole grain to make it there or to get the benefits of it and then meats and beans um we want a cap protein in our diet the go have lean protein beans are a lean protein but if you're choosing meat it's uh the lean meats it's your your fish your poultry for those and how you cook it is important too so frying it up may not be the best choice but you can bake it roast it grill it you name it so this is a good just overall picture of how to have a good diet and all of these things if you follow it depending on how strictly you adhere to um you know certain diets or and this it gets all the nutrients that you need within your body um but it is talking to your doctor so what does your particular body need in variety of a food really helps get the nutrients you need because if we stick to just like meat and potatoes you're not getting everything we have to have a variety to get everything and that's what that chews my plate really helps with that but another way to look at it is make sure that your plate has a variety of color on it natural color not processed color but natural color foods that have color with them this is the great leafy greens the colory vegetables and fruits those really have the high nutrients in them the more colorful the better they are as far as nutrients go and the healthiest foods are the whole foods and we've generally found whole foods on the perimeter of the grocery store so if we can stay just on that perimeter instead of going down through the middle aisles that's where the more processed foods are so just stay on the perimeter and purchase food from there and being a smart shopper just knowing what labels say and how to read them and you know you might like a certain cookie but maybe we get one that has less sugar in it or something or the yogurt is a great example you want to have yogurt every day but there's some yogurts that have are highly processed and have a lot of added sugars in them and there are other yogurts that are better for you have higher protein higher fiber and natural no added sugars in them they just have the natural sugars so being smart about those and other you know it's talking to your doctor um if you have any unplanned weight loss or weight gain um it's really talking to your doctor about what's possibly going on here um if you've noticed difficulty in chewing or swallowing or you have it because it could be ill-fitting dentures or you do have some other oral health that could be really affecting your eating but also talking to them about oral nutrition supplements supplements can have a lot of fillers in them because they're not really regulated there's not they're not regulated by the fda so really talking to your doctor but what do i really need and what brand would you suggest i go with but also talking to the pharmacist as well what do you think as far as a brand would go for a certain nutrient you know an example i have is i do have to take iron as a supplement um that's prescribed by my doctor but that my doctor told me which brand that they would prefer i take because they have more evidence that it works better than other brands so really talking to them about that as well and if you have other barriers as far as transportation to get there or there are maybe financial issues on how to get there you there's a lot of help particularly in this community the fort worth dallas community to help with that there are there's the supplemental nutrition assistant programs and there's meals on wheels that can do home delivered and their nutritious meals and they offer a variety of other programs as well and how to find these resources for you you can call the tarrant county adrc which is aging and disability resource center and they can particularly find what you actually need and get you to the contact of the person that you really need to talk to and when i send you off the slides this afternoon i'll make sure and have the phone number um connected to that too there's some information about vitamin deficiency and persons that have some memory issues there is a study from the university of wisconsin that said 40 of geriatric memory patients were deficient in at least one vitamin linked to brain health and some of those vitamins are vitamin b so vitamin b6 b12 b1 and all of these vitamins really help with of course the glucose within our cells but in our neurons but also making sure our neurons work well um and the serotonin and the dopamine and epinephrine are working well in our brain so they're all the neurons to be able to communicate back and forth with each other another vitamin that's important to brain health is vitamin d and there's there's more and more studies coming out about vitamin d and how it contributes to brain health but also bones and healthy bones skin and metabolism and it says i'll say our study shows that many memory patients do have significant deficiencies in vitamins that affect memory treating these deficiencies is critical for improving memory function and efficient response to memory treatments so whether you would know somebody that has dementia already are already living with memory issues treating vitamin deficiencies can help that condition do better so we're not saying it's going to treat it but it can help them do better and of course we want to check for ourselves as well malabsorption of vitamins and fats does increase as we get older particularly with the vitamins b6 and b12 and that is shown to slower neuropsychological effects and these neuropsychological effects or deficits you also see the same symptoms in young women with anorexia so there is you can have malabsorption of vitamins because the body's not um absorbing it correctly and that can be due just to getting older but it can be because of starvation malnutrition gastric bypass anybody that has an ibs or somebody that already has some cognitive impairments so they're not getting the right food and then there's a niacin deficiency in this um so it's the 3ds dementia dermatitis and diarrhea these are three symptoms that we see if somebody that has a niacin deficiency mostly it's found in alcoholics because they're not consuming the the nutrients the leafy greens the seafood and the protein and so they become malnourished and you see the niacin deficiency and you can find niacin in whole grains fish nuts meats but you can also see or the symptom of it would be a rapid weight loss of course diarrhea fatigue and sometimes severe memory loss if those are treated properly those symptoms can clear up now the mediterranean diet is one of the best diets to get all of these vitamins in of course it depends on how you adhere how strictly you adhere to the mediterranean diet but that diet really does include all of these nutrients and talking to your doctor about supplements the best way to get any type of supplement or nutrient or trace mineral into your diet is through your food your body absorbs and metabolizes food differently when you eat it as opposed to when you take a pill but sometimes we might have to take a supplement right and like i mentioned earlier the supplement industry is not really regulated um so really talking to because it can be filled with a lot of fillers so really talking to that pharmacist about what do they recommend as a better brand to go with or doing your own research of course but folic acid has been shown for essential brain health brain function and emotional health as well it helps with the production of the neurotransmitters in the brain and it helps decrease um excuse me increase in nitric oxide which is it has a protective ingredient in our brain it helps it's it helps against oxidative stress or it helps against um it's kind of like an antioxidant so it helps get rid of the trash um or the waste that our cells can make throughout the day but low folic acid has been associated with depression sleep issues confusion appetite loss and if we have appetite loss we might have an increase for other malnourishment issues and then seizures as well and then again vitamins b6 and b12 um are related to brain health and our body doesn't absorb it as well as we get older so some people can be deficient in it but that can be an easy fix with a vitamin or b12 or b6 injection but you can also find it in the things listed here salmons chickens fortified cereals beef liver and then vitamin e has antioxidant effects as well so it helps clean out the waste that our cells make throughout the day and found in certain nuts and oils spinach and broccoli and then vitamin d like i mentioned earlier um you can get vitamin d through of course um sun exposure on your skin but also in oily fish eggs mushrooms and like i mentioned they're coming out with more studies about vitamin d and then i want to talk about crit spell jacob disease and this is a very rare disease it's a one in a million disease so about one person and one millions have have this disease worldwide so it's a worldwide thing and it's typical onset is 60 years old but it can be shown in much younger as that as well and i'm going to call it cjd disease but it is a human prion disease and a prion is it's what happens is there's a protein in our brain and the prions that prions kind of align the outside of the protein well those prions become toxic and what they're doing is that becomes toxic and that in that neuron and the prion is able to multiply very rapidly um so then it starts to attack all the other neurons because of how it's quickly it's able to multiply and take over all the other neurons and when it takes over these neurons the neuron dies and it withers away so it looks like um on the pictures it looks like there's little holes in the brain where the neurons are so it can they call it a spongy form type dementia because it looks like the brain looks like a sponge because of how it kills the neurons this disease is very rapid so usually somebody kind of comes on pretty suddenly we'll see the symptoms and then it progresses rapidly and they usually pass away within one year of onset of the illness the cjd does have a couple of different variances in their so i mentioned they all belong to a disease known as spongy form encephalopathies and this again because of the spongy holes that it makes on the brain tissue this is a picture of what it looks like and you can see on the right side and it does look like a sponge and this how the brain looks in this picture is different than what it would look like with an alzheimer's disease or a vascular dementia so the effects of the disease how it kills the brain is different so the variances of cjdr there's the classic or sporadic cjd and this is mean it appears for no reason we have no idea why it appears in that one and one million person there's no risk factor but it accounts for about 85 to 90 percent of all the cases of cjd it tends to develop around people ages 60 but it is also developed much younger in persons in their 20s and 30s there's also hereditary tj cjd and this is somebody that has tested positive for a genetic mutation that causes cjd so if a parent has it and it's a genetic or a hereditary cjd um they can 50 chance they pass it on to a kid they can be tested for it and then there's acquired cjd and this is very rare but it's transmitted by exposure to brain tissue or nervous system tissue that has been contaminated and this can be from equipment and like surgical procedures or blood transfusions um that may have happened again extremely rare that it happens what you might have heard of cjd um or has been termed the mad cow disease because in the early 1990s um we did it did get our attention in the uk um there was a acquired cjd um because people certain got cjd from eating meat from a diseased cattle so that was termed the mad cow disease we've never seen this form of cjd in america and it's it's really linked to contaminated beef which it's pretty much non-existent now uh but that's what we did see it there in the early 1990s but like i mentioned it does come on pretty suddenly um so you have um sudden changes and there are continuous changes rapidly over that course of about one year um and you can see personality changes so you can see um whether it's depression or agitation or apathy or mood swings severe confusion memory loss they can have blurred vision or blindness that happens pretty rapidly insomnia muscle stiffness so it's like they're stuck they can't move their muscles difficulty speaking swallowing and then sudden jerky movements is um kind of a more hallmark sign is there and they're not necessarily aware of those sudden jerky movements or that they're going to come on they're just happening and then eventually they will lose the ability to move or to speak and can enter in a coma and again the progression is about one year so we have here some references on malnourishment nutritional deficiencies i'm eating tips for seniors and how to detect malnourishment seniors and then also references on getting help for alcohol and drug use disorder as well i'll add that beers criteria um list or link on there if anybody wants to link directly to that virus criteria as far as medication interactions as well when i send that out this afternoon um there's our information but i'm going to stop sharing and see if there is any questions or anything anybody wants to share and i will um i had a comment and i appreciate it said depression is not a choice so be careful how you word that and that is very true absolutely depression is not a choice but we absolutely want to be able to treat get help for depression and treat it as best we can so thank you are there any other questions or comments jamie we might just uh do a reminder of the because this is a series that we're doing on less common dimensions and so uh next week we're actually going to talk about um lyme disease huntington's um house strut stress so with this is going to be a series for the next few weeks and it will be at the same time on mondays so it's very interesting whenever you really start kind of looking into this so that's why we decided to do this because this is something we have a lot of questions about yes thank you holly and i'll make sure you'll get the information about those um the series in the follow-up email this afternoon as well well we appreciate your time hope by five extra minutes in your day be looking for that email this afternoon with the additional resources and hopefully we see y'all next week thank y'all

Channel: James L. West Center for Dementia Care

Views: 6,854

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Id: k-ODgZgu218

Length: 54min 50sec (3290 seconds)

Published: Thu Nov 04 2021