Footprints to Cognitive Decline and Alzheimer’s Are Seen in Gait

Footprints to Cognitive Decline and Alzheimer’s Are Seen in Gait

The way people walk appears to speak volumes about the way they think, so much so that changes in an older person’s gait appear to be an early indicator of cognitive impairment, including Alzheimer’s disease. Five studies presented at the Alzheimer’s Association International Conference in Vancouver this month provide striking evidence that when a person’s walk gets slower or becomes more variable or less controlled, his cognitive function is also suffering. Thinking skills like memory, planning activities or processing information decline almost in parallel with the ability to walk fluidly, these studies show. In other words, the more trouble people have walking, the more trouble they have thinking. “Changes in walking may predate actually observable cognitive changes in people who are on their way to developing dementia,” said Molly Wagster, chief of the National Institute on Aging’s behavioral and systems neuroscience branch. Experts said the studies could lead to developing a relatively simple tool that doctors could use to forecast, if not diagnose, possible Alzheimer’s disease. “You can probably just watch them walk down the hall in your office and look for people who are starting to show deterioration in their gait and have no other explanation for it,” said William Thies, the chief medical and scientific officer for the Alzheimer’s Association. “If gait begins to deteriorate, we begin to have a conversation about how is your memory.” While scientists have studied gait changes after a heart attack or stroke and in diseases like Parkinson’s, they have only recently begun studying connections between walking and cognition. For decades, people thought slower walking was just part of getting old, but research shows some changes in gait signify problems that go beyond normal aging. “It’s like driving a car — you need an engine, a chassis and steering,” said Dr. Stephanie Studenski, an expert on walking who was not involved in the dementia studies. The engine of walking is the heart, lungs and blood, she said. The chassis is the muscles, joints and bones. And the steering is “the wiring — the nervous system,” said Dr. Studenski, a geriatrician at the University of Pittsburgh and the Pittsburgh Veterans Administration. “People who are focused on cognition largely never watch people move,” Dr. Studenski said. “The tests are all done sitting down. But damage to the wiring is an important shared problem of difficulty with thinking and difficulty with moving.” The new studies were larger and more detailed than previous research, and involved sophisticated measures of changes in gait. Some used an electronic walkway, a long mat outfitted with sensors that measure small differences in walking speed, cadence (the number of steps per minute), the width of the stride and variability (how often the person’s stride changes). The studies...

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Documentary Explores Music’s Effect On The Elderly

Documentary Explores Music’s Effect On The Elderly

Music’s therapeutic benefits have been well documented, but a new film called “Alive Inside” set out to examine just how therapeutic it can be in one community in particular — the elderly. The film, by Michael Rossato-Bennett, and featuring commentary by social worker Dan Cohen and neurologist Oliver Sacks, author of “Musicophilia,” captures the transformation that takes place when nursing home patients are handed iPods loaded with music from their youth. “He used to always sit on the unit with his head [down]…he didn’t really talk,” says caretaker Yvonne Russell of an elderly man introduced in the film as “Henry.” Henry’s daughter describes the once fun-loving man she knew, who used to sing every chance he got, encouraging his children to sing along, even stopping sometimes to sing and swing around poles. Her memory is a stark contrast to the Henry we first see in the film, an old man who’s been in the home for ten years and who now sits hunched over in his chair, incapable of answering questions beyond a yes or no. But when Cohen and Sacks put their Music & Memory theory to the test, handing Henry and other patients suffering from degenerative diseases an iPod full of music, a different person emerges. “Immediately he lights up. His face assumes expression, his eyes open wide…he’s being animated by the music,” Sacks says, describing Henry’s reaction. He can even engage in dialogue with an interviewer who asks about the effect the music has on him. “It gives me the feeling of love, of romance. I figure right now the world needs to come into music, singing. You’ve got beautiful music here,” Henry says, before breaking into a version of “I’ll Be Home For Christmas” by an artist he says is one of his favorite — Cab Calloway. The documentary’s findings are not unlike previous ones. In 2010, researchers at Boston University found that music can not only arouse dormant memories, but may also help people with dementia retain new information. Another study published last year revealed that lifelong musical training can actually offset some of the deleterious effects of aging, including memory loss and difficulty hearing speech. Cohen’s Music & Memory organization is soliciting donations of used and new iPods to put music in the hands of nursing home patients across the country. His documentary “Alive Inside” is slated to premiere on April 18 at the Rubin Museum in New York. From The Huffington Post See the original article...

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Another Hospital Hazard for the Elderly

Another Hospital Hazard for the Elderly

Hours before she fell and broke her hip, my mother, 85, lucid and whip-smart, was doing what she always did in the morning: drinking an entire pot of coffee and digesting both The New York Times and The Baltimore Sun. The next day she came out of the hip surgery just fine. But within 24 hours, a totally different woman seemed to have taken over her capable mind and body. She was disoriented. “This isn’t a very nice hotel,” she told us in the hospital room. “They haven’t even served cocktails. Let’s go.” My father, sister and I laughed, thinking it was just grogginess from the anesthesia. But then she developed trouble breathing, and the nurses clapped on an oxygen mask and whisked her off to another ward for more intensive monitoring. Things quickly spiraled out of control. She tried to rip off her oxygen mask and IV tubes. She frantically tugged at the sheets and her skimpy hospital gown. Like the aged Lady Macbeth, she kept saying: “We have to clean this up! Clean this mess!” They tied her hands to the bed. The medications to calm her down didn’t work. The doctors upped the sedation. Later, the physical therapist could barely rouse her to do the critical rehab on her brand-new hip. What my family didn’t know at the time, because the doctors did not tell us, was that this frightening transformation was a classic case of hospital delirium — a brain dysfunction characterized by sudden confusion and inattention. It’s one of the most common, dangerous and costly complications of hospital stays for the elderly.   This type of delirium results in large part from the actions of medical workers, according to Dr. E. Wesley Ely, a professor of medicine and critical care at Vanderbilt University School of Medicine. “Even well-meaning doctors are doing damage without knowing it,” he said. A host of medications can upset brain function and trigger delirium by interfering with the neurotransmitters (especially acetylcholine) that communicate between nerve cells. The long list includes sedatives, sleeping pills, narcotic painkillers and some allergy, blood pressure and incontinence drugs. Immobilizing patents can exacerbate the risk, experts say. Each year 20 percent of the 11.8 million elderly patients in hospitals develop delirium, including 60 percent to 85 percent of those in intensive care on ventilationand more than half of postoperative surgical patients. Even though it’s common, hospital delirium is still not being identified or treated as effectively as new research has shown it can be. “This dysfunction is grossly underrecognized, especially in the I.C.U.’s, because everybody in an I.C.U. is intubated and on a ventilator,” Dr. Ely said. “They can’t talk to you.” Here’s another thing my family didn’t know:...

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After Hospitalization, Mental Trouble for Elderly Patients

After Hospitalization, Mental Trouble for Elderly Patients

Many older people fear that a hospital stay could leave them even more disabled than they were before. Unfortunately, there’s new reason to believe this fear is justified. Elderly patients who are hospitalized are at much higher risk of cognitive problems afterward, according to a study published on Wednesday in the journal Neurology. The cause is unclear: Both the illness that brought the patient to the hospital and the treatments received there may contribute. But the risk appeared to last for years, said Robert Wilson, lead author of the report and a professor of neurological and behavioral sciences at Rush University Medical Center in Chicago. Dr. Wilson and his colleagues examined data on 1,335 people age 65 and older participating in the Chicago Health and Aging Project, a long-term study of chronic illness in three racially mixed Chicago neighborhoods. All of the patients were hospitalized at some point between January 1993 and December 2007. They were interviewed every three years and given tests of mental status. At least one interview occurred before a hospitalization and two interviews after, allowing changes in mental status to be tracked over time. The researchers found that the rate of cognitive decline in older patients more than doubled after a hospital stay, generally affecting thinking and memory across the board. Before these older people were admitted, mental test scores slipped 0.031 units per year on average; after a hospitalization, the decline was 0.075 units annually on average. “Essentially, it’s as if people became 10 years older, from a cognitive standpoint, than they actually were before a hospitalization,” Dr. Wilson said. Especially vulnerable to this effect were patients with more serious illnesses who stayed in the hospital for longer periods of time, and patients who started experiencing worsening memory and thinking problems before they were admitted. “We think that a hospital stay can help unmask and accelerate previously unidentified cognitive problems,” Dr. Wilson said. Not every older patient who goes to the hospital will experience these kinds of issues, Dr. Wilson added; many return home after an acute-care stay without any kind of impairment. It’s already known that a hospital stay can interfere with an older person’s physical functioning and ability to perform the so-called activities of daily living — bathing, toileting, dressing and so on — said Dr. Kenneth Covinsky, professor of geriatrics at the University of California, San Francisco. “What this new research does is add another layer and show that there’s also this cognitive loss that’s occurring,” he said. “While we suspected this before, there wasn’t strong enough data to firmly establish it before this study.” What explains the loss? Dr. Malaz Boustani, associate professor of medicine at Indiana University, suspects the culprit is...

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