Link Between Passive Smoking And Dementia

An international study by scientists in China, the UK and USA has found a link
between passive smoking and syndromes of dementia.

The study of nearly 6,000
people in five provinces in China reveals that people exposed to passive smoking
have a significantly increased risk of severe dementia syndromes.

Passive smoking, also known as ‘second-hand’ smoke or environmental
tobacco smoke (ETS), is known to cause serious cardiovascular and respiratory
diseases, including coronary heart disease and lung cancer. However,
until now it has been uncertain whether ETS increases the risk of dementia,
mainly due to lack of research. Previous studies have shown an association
between ETS and cognitive impairment, but this is the first to find a
significant link with dementia syndromes.

The study, published in
Occupational and Environmental Medicine, is a collaboration between scientists
at King’s College London and Anhui Medical University, China, along with
colleagues in the UK and USA.

According to the World Health Organization
(WHO), nearly 80 percent of the more than one billion smokers worldwide live in
low- and middle-income countries, where the burden of tobacco-related illness
and death is heaviest; but only 11 percent of the world’s population are
protected by comprehensive smoke-free laws.

China is the largest
consumer of tobacco in the world, with 350 million smokers. Since 2006, the
Chinese government has actively promoted the introduction of smoke-free
environments in hospitals, schools, on public transport and in other public
places, but implementation has not been widespread.

Recent data show
that the prevalence of passive smoking is still high, with over 50 percent of
people exposed to environmental tobacco smoke on a daily basis. China also has
the highest number of dementia sufferers in the world, with increasing rates of
new cases as the population ages.

Dr Ruoling Chen, senior lecturer in
public health from King’s College London, and colleagues interviewed 5,921
people aged over 60 in the rural and urban communities of Anhui, Guangdong,
Heilongjiang, Shanghai and Shanxi to characterise their levels of ETS exposure,
smoking habits and assess levels of dementia syndromes.

They found that
10 percent of the group had severe dementia syndromes. This was significantly
related to exposure level and duration of passive smoking. The associations with
severe syndromes were found in people who had never smoked and in former and
current smokers.

The data from the Anhui cohort, which were collected at
baseline in 2001-03 for dementia syndromes and in the follow up in 2007-08 for
ETS exposure and dementia, further excluded the possibility that dementia
syndromes caused people to be more exposed to environmental tobacco smoke.

Dr Ruoling Chen, also a visiting professor at Anhui Medical University
said: ‘Passive smoking should be considered an important risk factor for severe
dementia syndromes, as this study in China shows. Avoiding exposure to ETS may
reduce the risk of severe dementia syndromes.

‘China, along with many
other countries, now has a significantly ageing population, so dementia has a
significant impact not only on the patients but on their families and carers.
It’s a huge burden on society.’

The findings from this study, together
with a second recent study by Chen and colleagues published in Alzheimer’s &
Dementia on the links between passive smoking and Alzheimer’s disease, strengthen the case for
public health measures to protect people from exposure to environmental tobacco

‘At present, we know that about 90 percent of the world’s
population live in countries without smoke-free public areas. More campaigns
against tobacco exposure in the general population will help decrease the risk
of severe dementia syndromes and reduce the dementia epidemic worldwide.’

He added: ‘The increased risk of severe dementia syndromes in those
exposed to passive smoking is similar to increased risk of coronary heart
disease – suggesting that urgent preventive measures should be taken, not just
in China but many other countries.’


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Could Alcohol Be Bad for Your Brain?

VANCOUVER, July 18, 2012 – Light to moderate alcohol consumption has generally been considered to have some health benefits, including possibly reducing risk of cognitive decline. However, two studies reported today at the Alzheimer’s Association International Conference® 2012 (AAIC® 2012) in Vancouver suggest that moderate alcohol use in late-life, heavier use earlier in life, and “binge” drinking in late-life increase risk of cognitive decline.

“The many dangers of misuse of alcohol, and some of its possible benefits, have been widely reported, and there needs to be further clarification by the scientific community,” said William Thies, PhD, Alzheimer’s Association® chief medical and scientific officer. “Certainly no one should start drinking in order to reduce Alzheimer’s risk, as these two new reports attest.”

“We need to know more about what factors actually raise and lower risk for cognitive decline and Alzheimer’s disease. To do that, we need longer term studies in larger and more diverse populations, and we need more research funding to make that happen. We have learned incredible amounts about heart disease and stroke risk from long-term research like the Framingham Study – we have solidly proven lifestyle risk factors that people can act on every day. Alzheimer’s now needs its version of that research,” Thies added.

“In 2050, care for people with Alzheimer’s will cost the U.S. more than $1 trillion, creating an enormous strain on the healthcare system, families, and federal and state budgets. Recognizing this growing crisis, the first-ever U.S. National Plan to Address Alzheimer’s was unveiled in May. Now this plan must be swiftly and effectively implemented. We need Congress to support this implementation with an additional $100 million for Alzheimer’s research, education, outreach and community support,” Thies said.

20-year alcohol consumption patterns and cognitive impairment in older women

Whether moderate alcohol consumption has an impact on cognitive impairment in late-life is unsettled with some studies suggesting a protective effect. To date, few studies have examined patterns of alcohol consumption over time in relation to cognitive status, especially in very late-life.

Tina Hoang, MSPH, of NCIRE/The Veterans Health Research Institute, San Francisco and the University of California, San Francisco, and colleagues followed more than 1,300 women aged 65 and older for 20 years. They measured frequency of current and past alcohol use at the beginning, midpoint (years 6 and 8) and late phases (years 10 and 16) of the study. The researchers assessed participants at the end of the study for mild cognitive impairment and dementia. At baseline, 40.6% were nondrinkers, 50.4% were light drinkers (0 to 7 drinks/week), and 9.0% were moderate drinkers (7 to 14 drinks/week). Heavy drinkers (14 drinks/week) were excluded.

The scientists found that:

  • Women who reported drinking more in the past than at the beginning of the study were at 30% increased risk of developing cognitive impairment.
  • Moderate drinkers at baseline or at midpoint had similar risk of cognitive impairment to non-drinkers; however, moderate drinkers in the late phase of the study were roughly 60% more likely to develop cognitive impairment.
  • Women who changed from nondrinking to drinking over the course of the study had a 200% increased risk of cognitive impairment.

“In this group of older women, moderate alcohol consumption was not protective,” Hoang said. “We found that heavier use earlier in life, moderate use in late-life, and transitioning to drinking in late-life were associated with an increased risk of developing cognitive impairment. These findings suggest that alcohol use in late-life may not be beneficial for cognitive function in older women.”

“It may be that the brains of oldest old adults are more vulnerable to the effects of alcohol, but it is also possible that factors associated with changing alcohol use related to coping or loss could be involved. Clinicians should carefully assess their older patients for both how much they drink and any changes in patterns of alcohol use,” Hoang added.

Binge drinking increases risk of cognitive decline in older adults

Little is known about the cognitive effects of heavy episodic (or “binge”) drinking in older people. Binge drinking is a pattern of alcohol consumption in which someone who is not otherwise a heavy drinker consumes several drinks on one occasion.

“We know that binge drinking can be harmful,” said Dr. Iain Lang of Peninsula College of Medicine and Dentistry, University of Exeter, UK. “For example, it can increase the risk of harm to the cardiovascular system, including the chance of developing heart disease, and it is related to increased risk of both intentional and unintentional injuries.”

According to Lang, it is not clear whether binge drinking in older adults has a damaging effect on cognitive health and whether it increases the risk a person will develop dementia.

Lang and colleagues conducted a secondary analysis of data from 5,075 participants aged 65 and older in the Health and Retirement Study (HRS), a biennial, longitudinal, nationally representative survey of U.S. adults age 50 and older, to assess the effects of binge drinking in older people on cognition and mood. Baseline data were collected in 2002 and participants were followed for eight years. Consumption of four or more drinks on one occasion was considered binge drinking. Cognitive function and memory were assessed using the Telephone Interview for Cognitive Status.

Binge drinking once a month or more was reported by 8.3% of men and 1.5% of women; binge drinking twice a month or more was reported by 4.3% of men and 0.5% of women.

The researchers found that:

  • Participants who reported heavy episodic drinking once per month were 62% more likely to be in the group experiencing the highest decline in cognitive function, and were 27% more likely to be in the group experiencing the highest amount of memory decline.
  • Participants reporting heavy episodic drinking twice per month or more were 147% more likely to be in the group experiencing the highest decline in cognitive function, and were 149% more likely to be in the group experiencing the highest amount of decline in memory.

Outcomes were similar in men and women when analyzed separately.

“In our group of community-dwelling older adults, binge drinking is associated with an increased risk of cognitive decline,” Lang said. “Those who reported binge drinking at least twice a month were more than twice as likely to have the greatest decline in both cognitive function and memory. These differences were present even when we took into account other factors known to be related to cognitive decline such as age and level of education.”

“This research has a number of implications. First, older people – and their physicians should be aware that binge drinking may increase their risk of experiencing cognitive decline and encouraged to change their drinking behaviors accordingly. Second, policymakers and public health specialists should know that binge drinking is not just a problem among adolescents and younger adults; we have to start thinking about older people when we are planning interventions to reduce binge drinking,” Lang added.

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Source: By Dr. Edgerly, research expert

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Finding In Home Care

In-home care includes a wide range of services provided in the home, rather than in a hospital or care facility. It can allow a person with Alzheimer’s or other dementia to stay in his or her own home. It also can be of great assistance to caregivers.

In-Home CareNot all in-home services are the same. Some in-home services provide non-medical help, such as assistance with daily living. Other in-home services involve medical care given by a licensed health professional, such as a nurse or physical therapist. Common types of in-home services include:

  • Companion services: Help with supervision, recreational activities or visiting.
  • Personal care services: Help with bathing, dressing, toileting, eating, exercising or other personal care.
  • Homemaker services: Help with housekeeping, shopping or meal preparation.

Skilled care: Help with wound care, injections, physical therapy and other medical needs by a licensed health professional. Often times, a home health care agency coordinates these types of skilled care services once they have been ordered by a physician.

Determining who will provide home care is an important decision. For some, using a home health agency is the best choice. And for others, an individual care provider is a better fit.

The following steps can be helpful when trying to find the right care:

  • Create a list of care needs and your expectations for how they will be met.
  • Call home care providers and find out what help they offer and if it meets your needs.
  • Meet with a prospective provider in your home for an interview; prepare questions beforehand.
  • Check references; some agencies may conduct criminal background checks. Ask if these have been conducted.

Questions to Ask Potential In-Home Providers:

  • Are you trained in first aid and CPR?
  • Do you have experience working with someone with dementia?
  • Are you trained in dementia care?
  • Are you with an agency? (If important to you)
  • Are you bonded (protects clients from potential losses caused by the employee)?
  • Are you able to provide references?
  • Are you available at the times needed?
  • Are you able to provide back-up, if sick?
  • Are you able to manage our specific health and behavioral care needs?

Costs for home care services vary depending on many factors, including what services are being provided, where you live, and whether the expenses qualify for Medicare or private insurance coverage.

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How to Respond to “I want to go home”

“I want to go home.”  Many caregivers hear this from their loved one even when their loved one is sitting in the living room of the home they have lived in for many years. It also happens when there’s a change in environment or routine.

It’s upsetting to think your loved one no longer recognizes the environment around them, but this is part of the disease. The person may not believe they are in their home because they truly don’t recognize it. Or that person is likely not speaking literally but searching for the feeling of home – a sense of familiarity, security or comfort. So, what do you do in this situation?

As you so often do, you want to connect to the emotions behind the words instead of reorienting them to their place. In other words, “connect, don’t correct.” Validate their emotions and try to meet the emotional need. A hug or hand holding can soothe. Ask them to tell you about home and they may be able to tell you about the feeling of home.

If it’s not upsetting, you can reminisce about home, possibly using photographs in a photo album.  If this upsets the person, distract them with a pleasurable activity – a walk, a favorite snack, or listening to music. You might need to make up an excuse as to why they can’t go home – “the house is being painted; we’ll go later” and distract with an activity.

Reassurance and comfort go a long way; let your loved one know they are safe, taken care of and loved.


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Aging and the Attitude of Health Care Providers

In many cultures in the world, elderly people are revered and their advice is sought and respected. In our culture, the wisdom, the knowledge and the social skills of the elderly are often overlooked and instead we focus on the mental and physical deficits of our older generation.


Because of this prevailing attitude, older people are generally regarded as less valuable than younger people. The younger person has responsibilities of raising a family, maintaining a career and supporting the economy. The older person generally has no responsibilities and in addition is a drag on the economy since a great part of the tax base must go towards the support of older Americans.


It is inevitable that medical care providers will often have this same attitude towards their older patients. As a result, if an older person has a medical complaint and the cause is not readily apparent, a medical practitioner is more likely to accept the condition as a consequence of old age and treat the symptoms with medication as opposed to aggressively trying to identify the problem. In younger people, if the medical complaint is interfering with normal daily function, typically a more concerted effort will be made to identify and correct the problem.


Many in the health care profession consider old age to be a disease itself. Any medical problems are inappropriately attributed to old age as if it were a medical condition. And since there is no cure for old age, appropriate tests and treatment are never performed. Thus, medical problems that may not be related to age and may just as frequently occur in younger people are often not treated.


Consider the following real-life case as an example of this attitude.


A 71 year old woman has surgery on her shoulder for a bone spur that is causing her considerable pain. The surgery is successful and she goes through several months of physical therapy to help her recover. But she is not recovering as expected. She continues to experience pain that radiates through her entire back. Her physical therapist does not know how to help her and attributes her failure to recover to old age.


She visits her family care doctor at least twice over the next six months complaining of extreme tiredness and lack of energy. Her skin color is gray and she does not look healthy. Her doctor tells her that older people don’t recover from surgery as quickly and what should she expect at her age.


Finally, in frustration, she visits her doctor and insists he check her for some problem since she is not recovering from the surgery and she feels awful.


After her insistence, he does a CBC blood lab and discovers she is severely anemic. He puts her in outpatient care and gives her four units of red blood cells and puts her on iron supplementation. Within two weeks the pain has disappeared and within a month she has recovered fully from the surgery. Numerous tests are done but there is no explanation for the anemia. Six months later she is healthy and active and her cheeks are ruddy.


When she asks her doctor why he did not suspect anemia, he tells her that she has never had anemia and based on her history he would never expect her to develop it. (He has no training in geriatric care.) He then tells her, in an obvious contradiction of his previous position, that older people sometimes fail to absorb iron. Ironically, she defends the action of her doctor and does not feel he acted inappropriately. 

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Dealing with Disabling Chronic Pain

Pain management is the process of bringing pain under control. Pain can be a problem with many people at the end of life. Persistent pain can accelerate the decline in health due to poor nutrition, depression, lack of social stimulation and lack of exercise. Persistent pain becomes a form of disability, interfering in the ability to perform common daily tasks. Here is a list of problems that pain causes to one’s self or to others:

·       It is difficult to sleep
·       It is difficult or impossible to pursue hobbies or personal activities
·       Exhaustion can become a constant companion
·       Depression is a very likely outcome
·       There is little desire to eat
·       It is difficult to enjoy the companionship of one’s family
·       There is reluctance to move about or exercise
·       The patient and the caregiver become more isolated from the community because of the disability
·       Family and friends who are caregivers become exhausted because of constant worry.
Chronic pain is a problem most often experienced by terminal patients who are dying from cancer.  Non-cancer patients at the end of life may have other pain-causing conditions.  This may be caused by such conditions as neuropathies, chronic back disorders or arthritis.
Chronic or ongoing pain only adds to the suffering of a critically ill person. If the pain can be brought under control, a seriously ill patient can have a better quality of life for the remaining time available to him or her.
Constant pain can also bring on depression, which in turn could lead to suicide. Many people who cannot endure chronic pain take their own lives or seek out assisted suicide. Pain management may be a better alternative than suicide, not so much for the patient but more for the family. If a loved one takes his or her life, that can produce a permanent scar of shame or guilt within the family.
The most common line of treatment in pain management is the use of medications. There are a number of helpful medications and herbal remedies to relieve chronic pain.  Psychologists who specialize in working with clients who have chronic pain are also available.  The human brain has a great deal of power over the pain a person feels and with correct therapy a person may be able to alleviate some of his or her suffering.
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Recognizing Symptoms of Dementia

The Brown family reunion has always been an event everyone looks forward to. Family visits, games, stories and everyone’s favorite foods are always on the agenda. On the top of the menu is Grandmas Lemon Coconut Cake. Grandma always makes the traditional cake from her old family recipe. This year, however, the cake tasted a little on the salty side, perhaps a half cup full of salty.

Though the family was disappointed over the cake, of more concern was Grandma’s confusion with the recipe and her similar confusion about the loved ones around her. Could something be wrong with grandma’s mental state?

One might say that for an elder person a little forgetfulness or confusion is normal, but when do you know if there is a serious problem, such as dementia?

An online article from outlines some common symptoms in recognizing dementia.

“Dementia causes many problems for the person who has it and for the person’s family. Many of the problems are caused by memory loss. Some common symptoms of dementia are listed below. Not everyone who has dementia will experience all of these symptoms.

  • Recent memory loss. All of us forget things for a while and then remember them later. People who have dementia often forget things, but they never remember them. They might ask you the same question over and over, each time forgetting that you’ve already given them the answer. They won’t even remember that they already asked the question.
  • Difficulty performing familiar tasks. People who have dementia might cook a meal but forget to serve it. They might even forget that they cooked it.
  • Problems with language. People who have dementia may forget simple words or use the wrong words. This makes it hard to understand what they want.
  • Time and place disorientation. People who have dementia may get lost on their own street. They may forget how they got to a certain place and how to get back home.
  • Poor judgment. Even a person who
    doesn’t have dementia might get distracted. But people who have dementia can forget simple things, like forgetting to put on a coat before going out in cold weather.
  • Problems with abstract thinking. Anybody might have trouble balancing a checkbook, but people who have dementia may forget what the numbers are and what has to be done with them.
  • Misplacing things. People who have dementia may put things in the wrong places. They might put an iron in the freezer or a wristwatch in the sugar bowl. Then they can’t find these things later.
  • Changes in mood. Everyone is moody at times, but people who have dementia may have fast mood swings, going from calm to tears to anger in a few minutes.
  • Personality changes. People who have dementia may have drastic changes in personality. They might become irritable, suspicious or fearful.
  • Loss of initiative. People who have dementia may become passive. They might not want to go places or see other people.”

Dementia is caused by change or destruction of brain cells. Often this change is a result of small strokes or blockage of blood cells, severe hypothyroidism or Alzheimer’s disease. There is a continuous decline in ability to perform normal daily activities. Personal care including dressing, bathing, preparing meals and even eating a meal eventually becomes impossible.

What can family members do if they suspect dementia? An appointment with the doctor or geriatric clinic is the first step to take. Depending on the cause and severity of the problem there are some medications that may help slow the process. Your doctor may recommend a care facility that specializes in dementia and Alzheimer’s. These facilities offer a variety of care options from day care with stimulating activities to part or full-time live-in options. Sometimes if patients tend to wander off, a locked facility is needed.

In the beginning family members find part time caregivers for their loved one. At first, loved ones need only a little help with remembering to do daily activities or prepare meals. As dementia progresses, caregiving demands often progress to 24 hour care. Night and day become confused and normal routines of sleeping, eating and functioning become more difficult for the patient. The demented person feels frustrated and may lash out in anger or fear. It is not uncommon for a child or spouse giving the care to quickly become overwhelmed and discouraged.

Family gatherings provide an excellent opportunity to discuss caregiving plans and whole family support. It is most helpful if everyone in the family is united in supporting a family caregiver in some meaningful way.

“The first step to holding a family meeting, and perhaps the most difficult one, is to get all interested persons together in one place at one time. If it’s a family gathering, perhaps a birthday, an anniversary or another special event could be used as a way to get all to meet. Or maybe even a special dinner might be an incentive.


The end of the meeting should consist of asking everyone present to make his or her commitment to support the plan. This might just simply be moral support and agreement to abide by the provisions or it is hoped that those attending will volunteer to do something constructive. This might mean commitments to providing care, transportation, financial support, making legal arrangements or some other tangible support.” The Four Steps of Long Term Care Planning

Professional home care services are an option to help families in the home. These providers are trained and skilled to help with dementia patients. Don’t forget care facilities as well. It may be the best loving care a family member can give is to place their loved one in a facility where that person is safely monitored and cared for.

The National Care Planning Council supports caregiving services throughout the country,

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