Newer Discoveries in Alzheimer’s Disease Research

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Alzheimer’s Disease (AD) is an increasingly prevalent topic in elder health care and studies, often with new information and research seen in news headlines weekly or monthly. Assisted Living Education covers some of these new discoveries in the latest research movements for Alzheimer’s treatments.

A good portion of these research and technologies are still in the early stages, and often haven’t gone beyond laboratory testing on mice. Much of this recent research has been conducted on mice engineered to display similar neuropathology as seen in a human individual with Alzheimer’s.  However, with these encouraging new discoveries, researchers are hoping to eventually replicate the successful results in humans as well.

Beta-Amyloid & Tau Tangles

Beta-amyloid plaques and tau protein tangles have been the target of heavy AD research for the last two to three decades. Analysis has indicated that people with AD have an increased amount of beta-amyloid plaques and tau, or neurofibrillary, tangles in their brain.

In a healthy brain, the cell transport system is arranged in what look microscopically like parallel lines, called microtubules. Nutrients and other materials flow along these lines, and normal tau proteins provide the structural support to keep these lines and order in tact. Sometimes, these tau proteins become corrupted, causing structural collapse and twisting. As a result, the transport system is disrupted and eventually leads to cell death. Tau pathologies have also been linked with other degenerative brain conditions, including frontotemporal lobe dementia, progressive supranuclear palsy, and chronic traumatic encephalopathy.

Previously, it was thought that beta-amyloid itself led to the development and acceleration of Alzheimer’s Disease. Interestingly, studies have revealed that not only are the tau tangles more indicative of Alzheimer’s destruction, but that the beta-amyloid is the one contributing to the corruption of the tau proteins, thus leading to the tau tangles.

Much of the current medical research has focused on either inhibiting the production or the clustering of these plaques by employing the body’s immune system against them. Researchers are experimenting with drugs called monoclonal antibodies, which mimic the body’s natural antibodies that act against foreign invaders. These can help prevent the clumping and assist the body in flushing the beta-amyloid from the brain. Tau aggregation inhibitors as well as other tau treatments are under current research as well.

Ultrasound Technologies

Ultrasound technologies are a novel approach that focuses on breaking up the plaques and tangles developed from beta-amyloid and tau proteins. A team in Queensland, Australia, led by Gerhard Leinenga and Jürgen Götz, developed what they call focused therapeutic ultrasound, which concentrates sound waves into brain tissue. The oscillations of the sound waves encourage the relaxation of the blood-brain barrier, and stimulate microglial cells to activate. Microglial cells are responsible for waste removal from the brain, and with their activation, they can clear out the beta-amyloid plaques.

To replicate ‘Alzheimer’s’ in the lab, researchers deposit beta-amyloid in the brains of mice. 75% of the mice tested experienced a full recovery in memory function and improved task performance from the ultrasound treatment. Better yet, this procedure is non-invasive with no damage to the surrounding brain tissue.

HSV-1 & Alzheimer’s

Some research has examined which, if any, environmental factors have played a part in the development of AD. A case has been made for the involvement of the HSV-1 (Herpes Simplex Virus 1), as a correlation between persistent brain infections caused by the virus has been noted.

HSV-1’s interaction with the body’s proteins during an active infection are thought to have a cumulative effect, especially with recurrent flare-ups. The virus interferes with the host’s cell processes, helping itself replicate and interfere with the proteins related to immune response. The host may even cause damage to itself in an attempt to combat the virus with increased inflammatory and immune responses, leading to a few different outcomes. In severe cases, affected individuals may develop herpes simplex encephalitis (HSE), but cell death and neurodegeneration are other effects that may initially go unnoticed.

In this approach, future AD treatments could involve the use of antiviral agents already used in targeting HSV-1, but interestingly, the use of statins as well. Statins help lower cholesterol, and it appears that they also have a role in regulating pathogen entry. This could help reduce the spread of HSV-1 throughout the body and brain.

Lack of Deep Sleep

There has been a long-time correlation between sleep disorders and those who suffer from AD, but common thought surmised that the brain’s sleep regulators were suffering from the effects of AD. Research is taking a new turn, suggesting that the lack of deep sleep is in fact contributing to the development of AD.

Healthy sleep enables restorative measures in the human body, purging toxins and repairing other body systems. However, the inability to acquire or reach deep sleep can lead to a build-up of these toxins, including beta-amyloid in the brain. While the body relies on the lymphatic system to help clear out its toxins and waste, the brain relies on the glymphatic system, named for the microglial cells responsible for toxin and waste removal specific to the organ.

General sleep disorders and those specific to Alzheimer’s research have undergone human trials, finding that lack of sleep causes poor memory and accumulation of beta-amyloid. A study by Mander, Jagust, and Walker discovered that powerful brain waves generated during non-REM sleep help solidify memories from their short-term state in the hippocampus to their long-term existence in the frontal cortex.

The positive side for these findings is that treatments for poor sleep are relatively easier to access. One aspect is as simple as exercising more, but behavioral therapy and even electrical stimulation have been found to improve sleep and memory performance as well.

Aberrant Immune Response

Much of the treatments that we have just discussed revolve around the idea that the accumulation of beta-amyloid plaques and tau protein tangles are the primary causes for symptoms in AD.

However, some of the newer research has taken a different approach. In light of questioning why over 99% of clinical trials for AD treatments have failed, some researchers suggest that the treatments have gone after the wrong targets. They suggest that an aberrant immune response is actually destroying the neural synapses – the crucial connections that pass messages among the neurons.

L-Arginine & Immune Suppression  

Basically, L-Arginine (or, arginine) is an amino acid essential for normal immune system function. In the past, some of the research has suggested that AD and other dementia disorders are a result of the body amping up its immune or inflammatory response. However, some research indicates that the immune response is actually suppressed, but in localized regions of the brain. In areas with accumulated beta-amyloid, there is an increase of arginase, an enzyme that catabolizes arginine, leading to an overall decrease of the amino acid in the brain. This also indicates that the neurons are suffering from nutrient deprivation from this excessive catabolization of arginine.

Arginine is found naturally in the human body, but is also present in our foods (meats, dairy, coconut, oats, walnuts, soybeans, peanuts, etc.). Though it would seem that increasing arginine in the diet would help counteract these negative effects, researchers are careful to warn that arginine supplementation will do little help in the case of AD. Though arginine levels may increase within the body, the blood-brain barrier has its limitations on how much it will allow to pass through. Instead, research has focused on inhibiting the arginase to prevent it from catabolizing arginine.

Synaptic Pruning & C1q Protein

Synaptic pruning is the process in which synapses that are either infrequently used or less efficient are marked for elimination. This is a normal and essential process in development, helping with brain function and efficiency.

However, like many things, this process can go awry. In this case, beta-amyloid and a protein called C1q seem to work together. C1q is another key component in immune response, the first in a chain reaction called a complement cascade. C1q binds to particular pathogens or other toxic cells/debris, ‘marking’ them for destruction. The other components in the complement cascade help advance the breakdown and elimination of these elements. The microglia are the immune cells specific to the brain that eliminate (ingest) cells or debris marked for destruction.

In individuals with AD, an excess of C1q was discovered especially at the synapses, amidst beta-amyloid plaques. According to Stanford Medicine, the levels of C1q were 300 times the average amount. It appears that overzealous C1q would mark too many synapses for destruction, while the beta-amyloid would stimulate the microglia to devour or engulf the synapse.

Researchers have found in the lab mice that inhibiting the C1q protein actually did stop this process. While their results have been successful with lab mice, they have a long way to go before seeing the human trials for this theory. Even so, it continues to open up new avenues in research involving the brain’s immune response and its effects on neurodegenerative disorders.

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Assisted Living Education recognizes the importance in staying abreast of relevant topics in the industry. As a premier provider in coursework and licensing for assisted living services, we offer comprehensive training in RCFE classes, continuing education, and current issues in the industry. Explore our website for a full array of services, or visit our contact page to submit any inquiries or reach immediate assistance.

 

Common Treatments and Therapies for the Alzheimer’s and Dementia Resident

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With the current prevalence of Alzheimer’s affecting 1 in 10 of anyone over age 65, and over half of people over 85, it’s no surprise the disease has been at the forefront of conversations lately in elderly healthcare.

Here, Assisted Living Education shares some of the common current therapies used in treating Alzheimer’s or other dementia patients. While many studies and new discoveries seem to appear weekly on this disease, these are the more popular ones available at the time of this writing.

Medications

While there is no cure for Alzheimer’s or other dementia disorders, there are medications that can help control or manage some of the cognitive and behavioral symptoms. Because AD/Dementia disorders affect the transmissions between neural pathways, the medications helping the cognitive aspect are designed to affect certain chemicals involved with these neural transmissions. Some of these medications can help with memory loss, cognition, confusion, and language, and some work through all stages of the disease, although most are only effective for a limited time due to the progressive nature of the disease.

The Alzheimer’s Association states at this time, there are about five drugs which have been FDA-approved in the treatment of symptoms in Alzheimer’s. As research progresses, other medications and treatments are being developed to address factors potentially contributing to these diseases. Elements that contribute to the development of the brain plaques and tangles seen in Alzheimer’s (specifically beta-amyloid, beta-secretase, and tau proteins) are current targets of research, as well as other factors like inflammation and insulin resistance.

Your resident’s doctor, psychiatrist or neurologist will determine or has determined which medications will be most effective for their care and treatment. However, in working with your residents, your daily observations can help assess whether continuing these treatments is beneficial.

Non-Pharmaceutical Therapies

Music

Music has proven to be a powerful therapy or aide for many people, including those with dementia and Alzheimer’s. From relaxing and enjoying a melodic moment, to using it as a tool to redirect or calm a resident from agitation, music can be appreciated in a variety of ways. Soothing music can help create a calm environment, while upbeat music can inspire energy in the room. It’s best to use music from a source without commercials or other interruptions, as it can break the flow and cause confusion for the resident.

Music is such a powerful tool because an individual’s aptitude and appreciation for music remains longer than many other faculties in the dementia brain. Music is also able to stir emotions and memories from long ago, waking the dementia-riddled brain to moments of lucidity, cognizance and even articulation. Research has revealed a strong connection between the auditory and limbic system, which processes emotions.

Encourage movement, dancing for the ambulatory resident, or clapping, swaying, even singing. Music, movement and singing are not mentally-demanding for an individual to process, but it can actually stimulate brain activity.

There is also research indicating that individuals with Parkinson’s Disease (another dementia-related disorder) are able to move better when there is music with a distinctive beat playing. They can actually synchronize their movements to the beat.

If your resident is unable to indicate which type of music they prefer, families are a good resource, if available. If nothing else, try finding music from the ‘30s, ‘40s, & ‘50s (or the decades when they would have been a teenager or young adult) or favorite musical classics like The Sound of Music, Singing in the Rain, or Wizard of Oz, e.g. Mixing in newer music that is unfamiliar to the resident is also useful, as there are no emotional attachments that could potentially elicit a sad/upsetting memory or response from them.

Art

Like music, art therapy can activate an individual’s brain and stimulate a positive response. Also like music, art can be a vehicle of expression for the individual who has trouble articulating ideas, feelings, and thoughts. Art can be a conversation piece and a way to connect with other people. Creating art can help reduce anxiety, stress, and even symptoms of depression. If a resident with dementia is frustrated or depressed in the reduction of their abilities, art therapy can give them a sense of validation and confidence as they create and complete their works.

Art and music are effective tools for communication and expression because they actually draw on many parts of the brain, not just the area involved with language.

Pet Therapy

For the resident who enjoys animals, pet therapy is a welcome highlight in the day. Pets are

often seen as non-threatening, and providers of unconditional love. Therapy animals have been carefully chosen and trained based on their temperament and ability to interact with large and different groups of people.

As many of us know in our personal lives, the presence of animals is extremely beneficial.  Spending time with an animal can be completely engaging and sensory, with the sights, sounds, scents, and tactile experiences they bring. Joy, stress relief, and reduced agitation are among the major benefits as well. For an individual with dementia, they also offer ease in physical interactions, and act as a vehicle for conversation, both of which may be otherwise difficult for the resident to access. Depending on the therapy animal and the organization, the resident may be allowed to walk or groom the animal, which can also provide a sense of responsibility. Studies have also shown that dementia residents will eat more after a visit with an animal, which can be a victory for those with appetite or other issues in undereating.

Of course, personal considerations must be made for each resident, whether they have allergies or any aversions to certain or all animals.

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In working and getting to know your residents further, you will learn what kinds of things they respond to better, and which things to avoid.

Because Alzheimer’s and dementia education is a crucial topic in elderly care, Assisted Living Education offers extensive courses in our training specifically designed to address the issues and demands of these conditions.

Assisted Living Education is dedicated to providing the best in quality training, support, and services for this industry. Please visit our contact page for any inquiries or requests. Explore our website for a full list of RCFE training and continuing education courses, licensing, and other products and services we provide for assisted living.

 

Caring for the Alzheimer’s or Dementia Resident

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The Alzheimer’s Association estimates that in 2015, 5.1 million Americans 65 or older had Alzheimer’s Disease (AD). With this in mind, AD and other forms of dementia are some of the most common conditions professionals will encounter in an assisted living or skilled nursing facility.

Dementia

“Dementia” is a generic term encompassing loss of memory and other cognitive functions severe enough to affect daily living. These deficits are caused by physical changes in the brain. Alzheimer’s is one of the most common and widely recognized forms of dementia, but other types of dementia include:

Vascular Dementia
Dementia with Lewy Bodies (DLB)
Parkinson’s Disease
Mixed Dementia
Frontotemporal Dementia
Creutzfeldt-Jakob Disease
Huntington’s Disease 
Normal Pressure Hydrocephalus
Wernicke-Korsakoff Syndrome

Dementia is a difficult disease, not just for the resident, but for family members and even the caregivers as well.  Caring for dementia residents requires a great deal of patience and empathy.

Interacting With Someone Who Has Dementia

Because dementia is physically affecting the brain, the effects are commonly seen through behavioral and cognitive changes, as well as changes in a person’s physical capabilities. As dementia advances, it can strip a person from much of the knowledge, social graces, learned behaviors, and coping mechanisms that we spend our entire lives developing.

Keep this in mind when working with residents affected by dementia. Social norms, problem-solving strategies, logic and reason will not always apply in your interactions. As you get to know your residents, you will learn their habits, challenges, comfort zones and more. Use this knowledge to your advantage; it can help you learn how to assuage their fears and potentially de-escalate a problem situation.

Professionalism, Respect & Dignity
Stress and emotions run high in the healthcare profession, making it even more imperative to keep a professional demeanor and maintain your disposition at all times. There will be days plagued with emergencies, or problem behaviors will escalate and your residents may lose control of their emotions and impulses. It is your responsibility to maintain a calm composure despite the seemingly ensuing chaos. People can also sense a poor attitude and feed off the negative energy, making interactions or routines even more difficult. Once your composure is lost, control of the situation is lost. Your residents and your coworkers are relying on you for consistency and even guidance.

Upholding respect and dignity are essential in elder care. People with dementia may do things incongruous with their chronological age: cradle a baby doll, forget how to use a fork, express things we may not understand, etc.  You may also need to accommodate them in many facets of daily living (grooming, hygiene, toileting, meal time, and more).  Remember, these are either symptoms of old age, or reminders that the dementia has affected those areas of their brain. Though they may have reduced capabilities, these people are still adults with a life story, and deserve to be treated as such.

Avoid talking about the resident or their condition in front of them, unless you are medically questioning or interviewing them. As much as they can seem unaware, they may understand to a certain degree, or even fully. Depending on the context, the resident might feel shame or humiliation if they are reminded about what they can no longer do.

Keep it Simple
People with dementia, especially in the advanced stages, have difficulty sequencing or following complex instructions. Keep your instructions or requests simple, and you may need to use verbal or physical cues or prompts, such as tapping on the faucet while asking them to wash their hands, or gently guiding their hands to the faucet. Their physical or occupational therapist(s) may have other instructions on verbally or physically guiding them as well.

Challenging Behaviors

Anger and frustration are common emotions among those with dementia, and some may resort to aggression or violence because they cannot find the appropriate way to express themselves. If you are experiencing noncompliance or aggression from your resident, trying to reason or exert control over them will often engage in a non-constructive power struggle. Discovering the root of the problem, or even redirecting the resident can help prevent escalation or de-escalate a situation.

Basic Needs
Depending on how advanced the dementia is, the resident may have difficulty expressing their basic needs as well, and act agitated or upset. If the cause is not apparent, run through a list of needs or issues that could be the trigger:

Do they need to use the restroom?
Do they need to be changed or cleaned up?
Are they hungry/thirsty?
Are they in pain?
Are they otherwise uncomfortable? Hot? Cold?
Is it fear? Confusion? Boredom?

Assisting a resident in addressing these basic needs can help improve their mood and keep them comfortable and content.

Noncompliance
If you experience simple noncompliance with your resident, try giving them options or choices. Remember, these once fully-functional adults have lost much of their independence and even pride. It is not always pleasant having someone else constantly making decisions for you. By giving the resident options, you afford them some control and choice in the situation. You can also try to ‘reward’ them with a preferred activity in exchange for your request. If the request is not urgent, you can always try again later.

Redirection:
People with dementia frequently exist in the moment because their brain has lost the capacity to account for the bigger picture or context. If they are troubled by something in that moment, they may act out or perseverate on the issue. Fear and confusion are common reasons for this, so a soothing, reassuring interaction can help calm the resident. Changing the environment or redirecting them to a different activity can help their mind switch gears. Music and singing are also incredibly therapeutic, and can serve as a great distraction as well.

Sundowning
Sundowning is a common phenomenon among people with Alzheimer’s and dementia. Agitation, confusion, and irritability increase as natural sunlight fades into the evening.

Keeping the residents active and engaged in activities throughout the day, and avoiding naps or overnapping can help residents sleep better through the night and help with sundowning symptoms. Avoid serving caffeine in late afternoon or evening, as it can also encourage night activity and irritation. Keeping residents on a regular schedule can help reduce confusion, and if useful, post a written schedule that can be referred to.

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Alzheimer’s, dementia, and its other related diseases or syndromes are an increasingly important topic in elderly healthcare. With Assisted Living Education, you can complete the Dementia Plan of Operation for your facility to serve the growing population of clients in this market. We also offer specific courses and continuing education in Alzheimer’s & Dementia Caregiving to help further educate you or your staff for the demands in this field. Explore our website for more information or contact us for any inquiries.

 

Welcome to Assisted Living Education

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We welcome you to our new blog for Assisted Living Education. In addition to our extensive Residential Care Facilities for the Elderly (RCFE) and Adult Residential Facilities (ARF) programs, our blog will serve as an additional resource with relevant topics in caregiving and the senior industry. Assisted Living Education is a Department of Social Services (DSS), NHA, BRN and PCE approved vendor. We provide RCFE Administrator certification classes, ARF certification, and many other classes and services useful for the RCFE industry.

The Assisted Living Education Advantage

Careers in elderly care are on the rise, with more than 88 million people, or 20% of the U.S. population, estimated to be over 65 by the year 2050 according to the U.S. Census. Considering a career in serving the elderly population is not only a viable option, but can be personally rewarding as well.

Assisted Living Education offers a unique program of comprehensive education, supportive services for new or existing RCFEs, plus Continuing Education (CE) units. With everything you need in one place, we can help you jumpstart and maintain a successful career in residential care for the elderly!

The Program

Our mission at Assisted Living Education is to ensure our courses and services provide you with the knowledge and skills necessary to be an outstanding performer for your residents, company, and the assisted living industry, and contribute to the advancement of assisted living care and service.

We also strive to provide excellence in quality instruction and training for coursework, licensing, and services in RCFE. Our teachers and staff are passionately committed to an all-encompassing educational experience for you and your RCFE facility’s success, and ultimately the well-being and quality of living we strive for in the ageing population. Here are 10 steps to open an RCFE in California providing by Assisted Living Education.

The coursework at Assisted Living Education provides the state-required hours for completing  and preparing for an RCFE Administrator certification. Topics included are resident care, Alzheimer’s & Dementia care, medication assistance, laws and regulations as well as the business aspect of operations, marketing, and other topics relevant to being an RCFE administrator.  The fun, fully engaging, and interactive classes are taught by professionals with years of industry and hands-on field experience. Their enthusiasm not only enhances the presentation of the required content, but their practical skills knowledge and experience from real-world situations enrich the learning process for everyone. Separate staff training for Caregiver, Medication Training, and Alzheimer’s & Dementia care is available as well. You’ll find a variety of live and online Continuing Education (CE) coursework, as well as RN, LVN, and SNF classes online.

Our program is designed to cover a wide scope of facility and staff requirements, plus specializations to attract a broader range of residents, increase your RCFE facility income, and better serve the diversity of needs in the elderly care community.

For existing facilities, we offer consulting and licensing services to ensure compliance with DSS as well as OSHA to help you avoid issues potentially leading to a fine. Our founder, owner, and a lead teacher at Assisted Living Education, Jane Van Dyke-Perez has established a solid relationship with DSS and assisted numerous facilities in licensing applications, approvals, and compliance. Her knowledge, expertise, and guidance have helped expedite licensing approvals by identifying and resolving issues that would otherwise have delayed the process by months.

Special Incentives

We realize starting a new career can be quite an investment. Assisted Living Education offers great savings on some of our products. Our RCFE Administrator Certification offers $50 off per person with the enrollment of 2 or more people. Take advantage of our training packages, including our  RCFE Licensing or RCFE Licensing application for operating your RCFE, or our ultimate RCFE in a Box, which includes everything you need to start your RCFE – over $700 worth of savings versus buying the materials separately.  We also have our RCFE update service available to help.

Upcoming Topics

Please come back to our blog soon as we will be discussing many interesting industry relevant topics such as…

—  The importance of good assessments

—  Documentation – when and how for your RCFE

—  Working with the Ombudsman

— Dealing with challenging family members, including how to handle difficult situations with residents and families

… And many more!

Final Thoughts

Lastly, we invite you to explore our website, and learn more about Assisted Living Education, with a special message from Jane Van Dyke-Perez on our homepage. For general questions, visit our FAQ page. Learn more about our history and get to know the dedicated team members integral to your RCFE experience. Please visit our contact page for any inquiries.

We welcome you aboard to the Assisted Living Education community!