Nursing home patients’ response to music opens new avenues for diagnosis and therapy

A nursing home in California began playing music for residents suffering from dementia, and got responses from patients once considered unreachable.

There are thousands of nursing homes participating in an international music and memory program.

At Villa Coronado, a nursing home in San Diego, 10 residents with traumatic brain injury were given an iPod to listen to music. Over 4,500 residents in 300 California nursing homes are taking part in a statewide experiment. One of the aims of the study is to find out whether music can replace antipsychotic drugs and restraints for agitated patients. With some patients, it seems to work.

This patient population receives little or no therapy, and are mostly bedridden, isolated from the world around them. Researchers are looking to see if the music program can reduce aggressive behavior.

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For some people, music brings back memories. It can help dementia patients become more aware of their surroundings. Music will bring a smile to some patients, and can calm those who are agitated. Some patients listening to the music will smile, move rhythmically, and be more responsive to their loved ones.

Music is said to activate more parts of the brain than any other stimulus. New research suggests music therapy could help people in a coma or in a vegetative state.

The patients’ response to music may even help physicians to diagnose consciousness. Studies show there is a high rate of misdiagnosis in vegetative patients, where it is important to determine a patient’s chance of recovery. Observing these patients leads some workers to conclude that rather than a steady state, there is a spectrum of consciousness, and patients drift in and out.

Caroline Schnakers is an associate clinical professor in the Department of Psychiatry at UCLA. Her research indicates there is a 40 to 50 percent error rate in diagnosing a patient’s consciousness. Some patients appear to be unconscious, and yet have some signs of consciousness and awareness of their surroundings.

A patient in a minimally conscious state (MCS) is considered to have more chance to recover than a patient in a vegetative state. If a patient is observed to be sometimes conscious, there is more hope of recovery. The diagnosis of a patient determines medical treatment and end-of-life decisions, so it’s important to diagnose correctly.

Some patients thought to be in a vegetative state are actually in a minimally conscious state, and they respond to the music. One nursing home activities director was excited to see how music affected the residents, saying they just come alive.

Researchers at UC Davis plan to have the initial results of their nursing home study by the end of this year. But regardless of whether music is able to replace medication, it’s worth giving patients music to improve their quality of life.

For more information on the care of dementia patients: Alzheimer’s on Guide To Long Term Care.

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After Disaster: New Emergency Requirements for Nursing Homes

During Hurricane Irma, 14 people died at The Rehabilitation Center at Hollywood Hills, Florida, due to a power outage that left residents in extreme heat. Lack of air conditioning made the building heat up like an oven. One of the victims died with a body temperature of 109.9 degrees. The nursing home’s owners now face criminal investigation and civil lawsuits.

In response to the tragedy, Florida Governor Rick Scott issued an emergency order requiring nursing homes to have generators that can run air conditioners.

The nursing home industry has brought court cases to challenge the emergency order. But in the meantime, state senators Lauren Book and Rene Garcia have filed bills to make the generator requirement a state law. Also, state senator Gary Farmer is preparing a more comprehensive Florida nursing home reform bill.

On the Federal level, U.S. Representative Debbie Wasserman Schultz is sponsoring a bill that will require nursing homes to have generators that can run air conditioning for at least 96 hours in the event of an emergency power outage. The bill will also put nursing homes on the top priority list, along with hospitals, for restoring power after a hurricane.

The Federal bill provides for loans to help small facilities comply with the new regulation. Homes that have fewer than 50 beds, or a private room monthly rate of $6,000 or less could qualify for a loan to get the generators and other required equipment. This bill also sets up higher fines for facilities that break the rules and adds nursing homes to the critical infrastructure list so power will be restored there first.

Nursing homes are among the most important resources for long term care. For more information about long term care insurance see the Guide To Long Term Care.

 

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Alzheimer’s drug: another take on Solanezumab

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The Alzheimer’s drug Solanezumab turned out to be a disappointment when clinical trials showed patients with long-established Alzheimer’s did not benefit from it. But a new study aims to find out if Solanezumab will help people who have high levels of amyloid in their brains but have not yet developed symptoms of Alzheimer’s.

Some people develop amyloid plaques in their brains years before Alzheimer’s disease symptoms appear. Amyloid plaques are a sticky buildup which accumulates outside nerve cells. These plaque formations can interfere with how the brain works, causing problems with memory and thinking. Research has shown that people with high levels of amyloid in their brains are more likely to develop Alzheimer’s disease, though some do not. The drug Solanezumab provides an antibody that binds to the amyloid proteins, and may slow the progression of the disease.

Dr. Brian Ott of Rhode Island Hospital is leading a study on the antibody drug. The vaccine is supposed to attach to the protein that makes neurofibrillary tangles in the brain, and block it from causing degeneration of other cells. This is the first study to find out whether Solanezumab can help prevent Alzheimer’s disease through early intervention.

The trial will examine healthy people ages 65 to 85, with normal memory. The subjects will undergo a Positron Emission Tomography (PET) scan to measure the amyloid in their brains. Participants must pass a general health screening and have normal brain function and memory, but an elevated amyloid level. The participants will be randomly assigned to get either the investigative antibody drug or a placebo by intravenous infusion every month. Three out of four participants will receive the drug, and the rest will get the placebo.

The study will last three years, and the results will show whether the drug can change the course of Alzheimer’s disease when given before symptoms start.

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Alzheimer’s is the sixth leading cause of death in America. It is the leading reason that people need long term care. For information on Alzheimer’s and long term care insurance, see the Guide To Long Term Care.

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Blood test coming to diagnose Alzheimer’s disease?

A research team has found a method to detect biomarkers of Alzheimer’s disease in blood platelets. The test uses a ratio between normal and abnormal brain tau proteins to identify those with Alzheimer’s disease and other neurodegenerative conditions.

The researchers found that the presence of abnormal tau proteins corresponds with decreased brain volume in parts of the brain where characteristics of Alzheimer’s appear.
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A non-invasive test for Alzheimer’s disease would help detect people at risk before symptoms develop, and make prevention and early treatment possible.

A study published in the Journal of Alzheimer’s Disease in 2016 described using levels of the protein clusterin to ascertain which dementia patients are at risk of Alzheimer’s. Also, a 2015 study focused on using metabolites in saliva to detect cognitive impairment.

In 2016, 5.4 million Americans were affected by Alzheimer’s disease. For more information, consult the Alzheimer’s @Guide To Long Term Care.


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How your nose can expose your risk of Alzheimer’s disease

Alzheimer’s researchers found that a person’s sense of smell declines strongly in the early stages of Alzheimer’s disease, suggesting a noninvasive “sniff test” for diagnosis.

The test can help identify the pre-dementia condition called mild cognitive impairment (MCI), which often progresses to Alzheimer’s dementia in a few years.

David Roalf, Assistant Professor at the Perelman School of Medicine, University of Pennsylvania, led a study in which scientists used a simple, commercially available test called the Sniffin’ Sticks Odour Identification Test. Subjects have 16 different odours to identify.

Along with the sniff test, researchers administered a standard cognitive test (the Montreal Cognitive Assessment) to 728 elderly people who had already been diagnosed by doctors as healthy, having mild cognitive impairment, or having Alzheimer’s disease.

The research team found that the sniff test, when combined with the cognitive test, increased diagnostic accuracy. The cognitive test alone identified 75% of people with mild cognitive impairment; after adding the sniff test, 87% of cases were identified.

Using the two tests together also helped the researchers to detect subjects with Alzheimer’s and those who were healthy, and to determine the degree of cognitive impairment.

Doctors believe it is more possible to help people with Alzheimer’s disease if they begin treatment before dementia symptoms appear.
Genworth 2015 Cost of Long-Term Care Survey Chart

Many people get Long Term Care Insurance to protect themselves and their families against the debilitating effects of Alzheimer’s and other dementias.


 

 

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Parkinson’s disease connected to bacteria in the gut

Some researchers have found a link between Parkinson’s disease and the bacteria in the digestive tract. The discovery may lead to a new way of treating Parkinson’s, through the digestive tract, rather than the brain. Finely targeted probiotics may be the answer. The scientists published their findings in the journal Cell.

Parkinson’s disease causes brain cells to accumulate excessive amounts of the protein alpha-synuclein and then die. Physical and mental effects include loss of motor function, tremors, shaking, and more. It seems to be caused by environmental factors rather than heredity.

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The researchers performed three different experiments that showed the link between bacteria in the gut and Parkinson’s disease. The experiments were performed on two sets of mice that were genetically modified so they overproduced the protein alpha-synuclein. One set of mice had bacteria in the gastrointestinal tract; the other set had none. Read more about the experiments at Cell.

So Parkinson’s patients may have bacteria in their guts that contribute to the disease, or lack beneficial bacteria that could prevent the disease. These patients have some kinds of bacteria in their digestive tracts that are not found in healthy people, and they lack some kinds of bacteria found in healthy people.

Parkinson’s disease is a debilitating neurodegenerative disorder. One million people in the United States and up to 10 million worldwide have Parkinson’s, making it the world’s second most common neurodegenerative disease after Alzheimer’s.

Past research indicates bacteria in the gut may also be connected with other diseases, such as multiple sclerosis. There has been found a type of bacteria that is a major cause of stomach (gastric) and upper small intestine (duodenal) ulcers.

To find out about insuring for the risk of these disabilities visit the Guide to Long Term Care


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Groundbreaking ideas tested in high-tech Alzheimer’s facilities

A new concept is revolutionizing the care of patients with dementia and Alzheimer’s disease.

The idea is an assisted living facility that is like a time capsule for residents. The home’s interior is designed to look like a small town in the 1940s. Each resident’s room is a small house, with a front porch light that turns on by timer every night. The carpet outside the rooms looks like grass, with “sidewalks” leading from one room to another. In the ceiling, fiber optics change from sunlight to stars for day and night. Chirping bird sounds make the space feel like outdoors. There is a movie theater, a barbershop, a saloon and salon and supermarket.

The idea is to set up an environment that nurtures memories, promotes functional independence, and stimulates new learning. This charming environment can trigger fond nostalgic memories that will help the residents relax. It also creates the feeling of living in a community rather than an institution.

The innovative environments are created by Jean Makesh, an occupational therapist who is CEO of The Lantern Group. The Lantern Group has Ohio facilities in Chagrin Falls, Ashtabula, and Madison, with plans to expand: website.

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For more information see “Alzheimer’s on GuideToLongTermCare.com

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