cognitive issues

Diet, Nutrition, and Parkinson’s: What you Need to Know

July 1, 2020 Life, Research

Diet and nutrition have been found to play a crucial role in Parkinson’s. In a recent ‘Ending Parkinson’s Disease: Live’ webinar on Parkinson’s EU, Parkinson’s expert Dr Bastiaan Bloem, epidemiologist Dr Alberto Ascherio and Parkinson’s campaigner Omotola Thomas, considered how different foods can affect the risk of diagnosis, maintaining bowel health and more.

We share five key takeaways from their discussion.

1. Which foods can affect your risk of developing Parkinson’s?

Diet, said Dr Bloem, “is a really hot topic in the field of Parkinson’s”. Alongside exercise, diet and nutrition “are the big new kids on the block when it comes to improving symptoms, and perhaps, slowing down the progression of the disease.”

Dr Bloem and Dr Ascherio praised the Mediterranean diet, which varies by country and region, for its potential to lower the risk of developing Parkinson’s. The Mediterranean diet is generally high in vegetables, fruits, grains, healthy fats and fish, and is typically low in meat and dairy. Such a diet is rich in nutrients and antioxidants, making it “better than the traditional Western diet”, according to Dr Ascherio.

On the other hand, Dr Bloem theorised that “a lifetime of exposure to dairy” is associated with a higher risk of developing Parkinson’s, likely due to the pesticides ingested by cattle from contaminated grass.

Dr Ascherio added: “I don’t think that globally, dairy products are known to be a major cause of pesticide exposure. Dairy also has other effects like reducing the level of uric acid in blood, which we found to be related to a risk of Parkinson’s disease.”

2. Could you be malnourished if you have Parkinson’s?

While Dr Bloem pointed out that a regular diet should offer all the necessary nutrients, he did note that vitamin D and vitamin C can be exceptions. “Many people, particularly when you age and particularly when you’re a woman, are at risk of developing a vitamin D deficiency. There are fascinating anecdotal reports of people taking vitamin D and experiencing improved motor symptoms.”

Meanwhile, he explained, vitamin C supplements can help to prevent bladder infections in Parkinson’s patients by acidifying the urine. “Bladder infections can trigger a cascade that leads to worsening Parkinson’s symptoms.”

Dr Bloem also debunked the use of supplements like vitamin E, curcumin and Coenzyme Q190, which have been found to offer no benefits to people with Parkinson’s.

3. How can you maintain your bowel health?

Bowel problems are common in Parkinson’s patients, which Dr Bloem said can be alleviated by drinking a lot of water and eating a diet rich in fibres. People with Parkinson’s should see their general practitioner for laxatives only if all else fails. “The rule is you need to have bowel movements at least once every other day.”

Thomas added: “I have a three litre water bottle that I finish by the end of the day. It is a challenge, but I try to finish it. Because I struggle very greatly with constipation, I take three or four ounces of prune juice in the morning and that seems to help me.”

4. How should you take your Parkinson’s medication?

As food can interfere with the efficacy of levodopa medication, Dr Bloem recommended taking levodopa at least half an hour before or after a meal. In particular, he advised that protein intake be spread across the day.

“For most patients, taking your medication with a protein rich meal including dairy products and meat, can reduce gastrointestinal absorption of your levodopa. So, you need the proteins in order to keep up your muscle strength and avoid weight loss but try to spread the proteins over the day.”

Thomas acknowledged that this can be hard to do. She said: “I have a struggle spreading my proteins with my levodopa because I can’t take more than 15mg of levodopa at a time, so I’m taking it every two hours.

“That is one of those things whereby theoretically, I know what I’m supposed to do, but practically, I’m not able to.”

5. Should a dietician be part of your standard Parkinson’s care?

Yes, said Dr Bloem. “I think paying attention to the gut is part of routine clinical care at every consultation for people with Parkinson’s. Parkinson’s starts in the gut for many patients and slow bowel movements are very common, impacting the efficacy of your medication and appetite for food. It needs attention.”

While a Parkinson’s doctor or nurse can offer useful dietary advice, Dr Bloem himself recommends that his patients see a dietician at least once. “I think it’s part of standard care.”

View the webcast.

View WPA’s “Ask the Expert” video on this topic with Michelle McDonagh, RD, Froedtert & Medical College of Wisconsin

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Pingpong May Help Reduce Some Parkinson’s Symptoms

March 1, 2020 Life, Research

The game of pingpong, or table tennis, may hold promise as a form of physical therapy for Parkinson’s disease, according to a preliminary study presented at the American Academy of Neurology’s 72nd Annual Meeting in Toronto, Canada.

The findings show that 12 Parkinson’s patients who participated in a pingpong exercise program once a week for six months experienced improvements in several symptoms, including facial expressions, posture and rigidity. They were also better at getting dressed and getting out of bed.

Parkinson’s disease is a movement disorder in which the brain chemical dopamine gradually declines. This process results in slowly worsening symptoms that include tremor, stiff limbs, slowed movements, impaired posture, walking problems, poor balance and speech changes.

“Pingpong, which is also called table tennis, is a form of aerobic exercise that has been shown in the general population to improve hand-eye coordination, sharpen reflexes, and stimulate the brain,” said study author Ken-ichi Inoue, M.D., of Fukuoka University in Fukuoka, Japan.

“We wanted to examine if people with Parkinson’s disease would see similar benefits that may in turn reduce some of their symptoms.”

The research involved 12 individuals with an average age of 73 with mild to moderate Parkinson’s disease. The participants had been diagnosed with Parkinson’s for an average of seven years. They were tested at the start of the study to see which symptoms they had and how severe the symptoms were.

The patients then played pingpong once a week for six months. During each weekly five-hour session, they performed stretching exercises followed by table tennis exercises with instruction from an experienced table tennis player.

The program was developed specifically for Parkinson’s disease patients by experienced players from the department of Sports Science of Fukuoka University.

Parkinson’s symptoms were evaluated again after three months and at the end of the study.

The results show that at both three months and six months, study participants experienced significant improvements in speech, handwriting, getting dressed, getting out of bed and walking. For example, at the beginning of the study, it took participants an average of more than two attempts to get out of bed. At the end of the study, it took an average of one attempt to get out of bed.

Study participants also experienced significant improvements in facial expression, posture, rigidity, slowness of movement and hand tremors. For example, for neck muscle rigidity, researchers assessed symptoms and scored each participant on a scale of 0 to 4 with a score of 1 representing minimal rigidity, 2 representing mild rigidity, 3 representing moderate rigidity and 4 representing severe rigidity. The average score for all participants at the start of the study was 3 compared to an average score of 2 at the end of the study.

Two participants experienced side effects; one person developed a backache and another person fell down.

“While this study is small, the results are encouraging because they show pingpong, a relatively inexpensive form of therapy, may improve some symptoms of Parkinson’s disease,” said Inoue. “A much larger study is now being planned to confirm these findings.”

The main limitation of the study was that participants were not compared to a control group of people with Parkinson’s disease who did not play pingpong. Another limitation was that a single specialist assessed the patients.

Article from Psychcentral.com.

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Parkinson’s & Driving Safety

February 1, 2020 Change, Life

The topic of driving can be a sensitive subject for folks with Parkinson’s disease (PD) and their care partners. Fortunately, just because one has a PD diagnosis does NOT necessarily mean that the freedom to drive needs to be taken away. There are many people with PD who continue to drive safely, years after they have been diagnosed.

However, we know that PD progresses over time. Symptoms change. Medications may be added and others stopped. Side effects from medications can change. New health problems may arise that make controlling PD more difficult. Because of these things, driving safety is an issue that requires re-evaluation from time to time. Independence and safety are priorities that should both be honored, while recognizing that sometimes modifications may need to be considered.

Things to consider when deciding whether to drive
Driving plays an important role in an individual’s sense of independence, personal control, and self-reliance, so giving up driving can be very difficult. People living with PD should consider the following questions when deciding whether or not to drive:

  • How is my vision? Can I see well at night? Can I distinguish colors, such as in traffic lights?
  • Would I be putting my passenger (friend or loved one) at risk?
  • How fast is my reaction time? Could I safely avoid a surprise obstacle in the road?
  • Has anyone (friend or family member) commented negatively on my ability to drive?
  • Can I handle multiple activities at the same time (whether driving or not)?
  • Can I effectively and quickly turn the wheel or step on the brake with enough strength?
  • Do my medications for PD (or other conditions) cause side effects like sleepiness, dizziness, blurred vision, or confusion?

These are understandable and important questions to be considered, but often people struggle with how to discuss the issue with loved ones or care partners. Sharing concerns or observations with a trusted friend or family member might be a good place to start.

In some cases, speaking with a doctor or professional, such as an occupational therapist, might be helpful. The American Occupational Therapy Association maintains a searchable database to help locate a Driving Rehabilitation Specialist so you or a family member may receive an assessment (https://www.aota.org/Practice/ Productive-Aging/Driving/driving-specialistsdirectory-search.aspx).

Driver Rehabilitation Specialists work with people of all ages and abilities, evaluating, training, and exploring alternative transportation solutions. Another tool for rating driving ability is offered by AAA at https://seniordriving.aaa.com/evaluate-yourdriving-ability/self-rating-tool/. Local rehabilitation hospitals also sometimes offer assistance in driver evaluation and training.

When the time comes that a person with PD needs to give up driving, it is important to remember that there are options. Public transportation can be an option. Friends and family members are often happy to help, and it is important not to be afraid to ask. Also, look into special shuttle services through local organizations and community centers.

Socialization and staying active help manage Parkinson’s symptoms. You don’t have to stay home once you are no longer driving.

 

Article from February 2020 issue of Dallas Area Parkinsonism Society newsletter.

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Exercise can improve non-motor symptoms of Parkinson’s disease

April 1, 2019 Education, Exercise

Exercise has potential to improve non-motor as well as motor symptoms of Parkinson’s disease (PD), including cognitive function, report investigators in a review published in the Journal of Parkinson’s Disease.

PD is a slowly progressive disorder that affects movement, muscle control, and balance. While traditionally regarded as a movement disorder, it is now known to be a heterogeneous multisystem disorder — in recognition of the significant impact that non-motor symptoms have on the quality of life of individuals affected by PD. It is widely acknowledged that physical exercise improves motor symptoms such as tremor, gait disturbances, and postural instability. However, the effect of exercise on non-motor symptoms in PD, especially cognitive function, is less clear.

The number of older people with and without PD that experience cognitive impairment is steadily increasing worldwide. It is associated not only with a substantial rise in healthcare costs, but also affects the quality of life of both patients and relatives or carers. Up to 57% of patients suffering from PD develop mild cognitive impairment within five years of their initial diagnosis, and if they survive more than ten years, the majority will eventually develop dementia. The underlying neurophysiological mechanisms for cognitive decline in PD are not completely understood, but an accumulation of amyloid plaques, mitochondrial dysfunction, and neurotransmitter changes are all suggested to contribute.

A comprehensive literature review was conducted by investigators from the Institute of Movement and Neurosciences, German Sport University, Cologne, Germany, and the VasoActive Research Group, School of Health and Sport Sciences, University of the Sunshine Coast, Queensland, Australia. The studies reviewed included investigations of the effects of coordination exercise, resistance exercise, and aerobic exercise on domain-specific cognitive function in patients with PD. “Physical exercise is generally associated with increased cognitive function in older adults, but the effects in individuals suffering from PD are not known,” explained lead investigator Tim Stuckenschneider, MA.

The researchers identified relevant studies published before March 2018. There were 11 studies included with a combined total of over five hundred patients with PD with a disease severity from stages 1 to 4 on the Hoehn & Yahr scale, which is used to describe the symptom progression of PD. In four studies, positive effects of exercise on cognition (memory, executive function, and global cognitive function) were shown with no negative effect of exercise on any cognitive domain. Furthermore, disease severity was generally improved by exercise interventions.

The investigators concluded that all modes of exercise are associated with improved cognitive function in individuals with PD, however, no clear picture of which exercise mode is most effective emerged as they may influence cognitive function differently. Aerobic exercise tended to improve memory best, but different forms of exercises such as treadmill training or stationary bike training may have different effects, although both are considered aerobic exercise. Future studies are needed that directly compare the effects of different exercise modes, as the number of high-quality research projects is still limited.

“The potential of exercise to improve motor and non-motor symptoms is promising and may help to decelerate disease progression in individuals affected by PD,” observed Stuckenschneider. “Exercise therapy needs to be, and often already is, an essential part of therapy in individuals with PD. However, it is mostly used to treat motor symptoms. As part of a holistic therapy, the potential of exercise to maintain or improve non-motor symptoms such as cognitive function in individuals with PD needs to be acknowledged, and the most effective treatment options need to be defined. This will not only help practitioners to recommend specific exercise programs, but also ultimately improve the quality of life of the individual. Our work shows that ‘exercise is medicine’ and should routinely be recommended for people with PD to help combat both the physical and cognitive challenges of the disease.”

Article from ScienceDaily.com.

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WPA in the Community

March 1, 2019 Awareness, Caregivers, Education

Assisted living communities are prepared to care for older adults, but they aren’t always familiar with Parkinson disease. When a new resident has Parkinson’s, they turn to WPA for help. Jeremy Otte, WPA’s director of outreach & education, is happy to connect with these facilities and spend time training their staff to recognize some of the unique challenges presented by Parkinson’s.

“We are a RCAC assisted living facility,” said Bonnie Cohn, RN, campus administrator for ProHealth Care Regency Senior Communities. “We see many residents that move in with very minimal effects of Parkinson’s and see how quickly their disease can progress.”

Regency Senior Communities recently invited Jeremy to help educate their staff. He visited their campuses in New Berlin, Muskego, and Brookfield, and gave five presentations for employees on different shifts.

“It was wonderful for him to be here to explain the different stages and what to watch for. It helped them to understand the reasons that a resident may have ‘freezing’ episodes, difficulty getting their thoughts across, or slow mobility,” Bonnie told us.

Jeremy also discussed the importance of administering medication at a certain time, helping staff to understand the impact medication can have on a resident’s quality of life. She was grateful that he helped the staff understand how to assist a resident who is have these issues.

If you are interested in having Jeremy speak at your community or agency, call our office at 414-312-6990.

 

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Top Senior Scams to be on the Lookout For

February 1, 2019 Awareness, Caregivers, Education, Life

Eras Senior Network of Waukesha County coordinates S.T.O.P. – an awareness program focusing on frauds and scams aimed at older adults.

In 2014, the Federal Trade Commission created the Pass it ON campaign aimed at encouraging people to share vital information about scams. The FTC encourages you to not only share gifts and food during the holidays, but also tips about scams targeting older adults.

Since 2016, Eras Senior Network has given 47 presentations to over 1,250 seniors and their caregivers about common scams targeting the senior population. Through our research and conversations with seniors who have experienced interactions with scam artists, we’ve collected a list of popular senior scams that we hope you’ll share with those you love.

Grandparent Scam: A scam artist calls a senior and says “Hi Grandma, it’s me!” Oftentimes the senior assumes they’re speaking to their grandchild and won’t even ask for a name. Sometimes, the scam artist pretends to be crying, which distorts their voice, making it easier for the senior to believe it could be their grandchild. The scammer will then tell the senior they are in some sort of trouble and will need money wired to them – and begs their “grandparent” not to tell their “parents”. To avoid this scam, ask the caller specific questions like their name, address, or something only your true grandchild would know – and never wire money or send gift cards through the internet!

Telemarketing “Yes” Scam: Telemarketing scam artists use a simple response to steal from you. In this scam, a senior will receive a call and be asked if they can hear the caller. The natural response is to say “yes”. Unfortunately, scam artists can record this response and use it to fraudulently authorize charges via the telephone, according to the Federal Communications Commission. The best way to avoid this is by screening your calls and only answering numbers you recognize, or finding another way to answer their question without saying the word “yes.”

Medicare Card Scams: As you may know, new Medicare cards without the individual’s social security number began being mailed in April 2018. With this comes the risk for Medicare related scams as predicted by the Better Business Bureau. Scam artists may ask you for your social security number or a payment in order to receive your card. Your new Medicare card will be sent to you automatically at no charge – you DO NOT need to do anything or pay anything for your new Medicare card to be mailed to you.

Spear Phishing: Spear phishing is an email or electronic communications scam targeted towards a specific individual, organization or business. Emails that look like they are from a friend or family member can actually be attempts to steal data. Before clicking on the message, hover your mouse (without clicking) above the sender’s email address to see if it is from the person you know. Phone calls may showing caller identification from a known person can also be spear phishing attempts. Once you realize the caller isn’t your friend or family member, hang up without saying anything!

Sharing what you know about frauds and scams may be the best gift you can give someone. If you feel like you have been a victim of a fraud or scam, contact your local police department by calling their non-emergency number.

Kathy Gale is Executive Director, Eras Senior Network, Inc. and a member of the Wisconsin Attorney General’s Task Force on Elder Abuse. S.T.O.P. Senior Frauds and Scams is brought to you by Eras through a grant from the Wisconsin Consumer Antifraud Fund at the Greater Milwaukee Foundation and the United Way of Greater Milwaukee and Waukesha County. More information about Eras Senior Network, Inc. can be found at www.ErasWaukesha.org.

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Contact sports increase Parkinson disease risk

August 1, 2018 Awareness, Life, Research

Injuries from playing contact sports, such as rugby, boxing, and martial arts, have been linked to a heightened risk of dementia. A new study now says that contact sports may actually lead to other neurodegenerative diseases, and it explains why.

At Medical News Today, we have covered studies linking brain injury — usually as a result of playing contact sports — with a higher risk of developing various conditions later in life.

One such study argued that brain injuries could accelerate the processes that bring about Alzheimer’s disease, which is the most common type of dementia. It is characterized most prominently by memory loss, a sense of disorientation, and an impaired ability to carry on a daily routine.

Numerous studies during the past few years have suggested that repeated head injuries obtained from participation in contact sports are linked to chronic traumatic encephalopathy (CTE), which is a degenerative brain disease that can lead to dementia.

Now, a study led by researchers from the Boston University School of Medicine in Massachusetts has found that people engaging in contact sports may also be more likely to develop Lewy body disease.

In that condition, a protein called alpha-synuclein forms abnormal deposits known as Lewy bodies in the brain. Lewy body disease is associated with dementia symptoms, as well as with Parkinson’s disease.

Traditionally, scientists have believed that the motor symptoms — such as tremors, slowness of movement, and difficulty walking — experienced by some athletes are attributable to CTE.

However, the researchers argue instead that those symptoms are actually a byproduct of Lewy body disease, independently of CTE.

“We found the number of years an individual was exposed to contact sports, including football, ice hockey, and boxing, was associated with the development of neocortical [Lewy body disease], and Lewy body disease, in turn, was associated with Parkinsonism and dementia,” says study author Dr. Thor Stein.

The researchers’ findings are now published in the Journal of Neuropathology and Experimental Neurology.

Risk increased in long-term sports players

Dr. Stein and team drew their conclusions after studying 694 donated brains from three sources: the Veteran’s Affairs-Boston University-Concussion Legacy FoundationBrain Bank, Boston University Alzheimer’s Disease Center, and the Framingham Heart Study.

They found that the total number of years that a person had spent playing contact sports was associated with an increased risk of developing Lewy bodies in the cerebral cortex.

People who participated in contact sports for over 8 years had the greatest risk of developing Lewy body disease — six times higher, in fact, than the increase in risk seen in people who had played contact sports for 8 years or under. Moreover, people who had both CTE and Lewy body disease had a higher risk of dementia and Parkinson’s than those who only had CTE.

These findings may not be surprising. After all, as the authors note, previous research had already shown that the number of years spent playing contact sports can be used to predict the severity of dementia-related pathology, as well as the severity of CTE in former players.

This research, the scientists add, builds on data provided by existing studies, though further efforts should be made to ascertain, with more exactitude, the health risks to which repeated brain injuries expose athletes.

“Future studies incorporating more participants with neocortical [Lewy body disease] and contact sports play will be necessary to more accurately determine the best threshold and risk of contact sports participation,” the researchers write.

 

Article from Medical News Today.

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Video: Not all disabilities are visible

July 1, 2018 Awareness, Education, Life

In this video from Parkinson’s UK, people all over the world talk about their Parkinson’s.

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Driving Dilemmas: Risk vs. Independence

July 1, 2018 Caregivers, Life

Driving a car is a symbol of independence and competence and is closely tied to an individual’s identity. It also represents freedom and control and allows older adults to gain easy access to social connections, health care, shopping, activities and even employment. At some point, however, it is predictable that driving skills will deteriorate and individuals will lose the ability to safely operate a vehicle. Even though age alone does not determine when a person needs to stop driving, the decision must be balanced with personal and public safety. Driving beyond one’s ability brings an increased safety risk or even life-threatening situations to all members of society. Statistics show that older drivers are more likely than others to receive traffic citations for failing to yield, making improper left turns, and running red lights or stop signs, which are all indications of a decrease in driving skills. Understandably, dealing with impaired older drivers is a delicate issue.

The road to driving cessation is anything but smooth. Each year, hundreds of thousands of older drivers across the country must face the end of their driving years and become transportation dependent. Unfortunately, finding other means of transportation has not noticeably improved in recent years, leading to a reluctance among older drivers to give up driving privileges and of families to remove the car keys. The primary issue facing older drivers is how to adapt to changes in driving performance while maintaining necessary mobility. Despite being a complicated issue, this process can be more successful when there is a partnership between the physician, older driver, family or caregiver.

Dramatic headlines like these have ignited national media debates and triggered the pressing need for more testing and evaluation of elderly drivers, especially with the swell of the Baby Boomer generation: “Family of four killed by an 80-year-old man driving the wrong way on Highway 169.  86-year-old driver killed 10 people when his vehicle plowed through a farmers’ market in southern California. 93-year-old man crashed his car into a Wal-Mart store, sending six people to the hospital and injuring a 1-year-old child.”

According to the Hartford Insurance Corporation, statistics of older drivers show that after age 75, there is a higher risk of being involved in a collision for every mile driven. The rate of risk is nearly equal to the risk of younger drivers ages 16 to 24. The rate of fatalities increases slightly after age 65 and significantly after age 75. Although older persons with health issues can be satisfactory drivers, they have a higher likelihood of injury or death in an accident.

Undoubtedly, an older adult’s sense of independence vs. driving risk equals a very sensitive and emotionally charged topic. Older adults may agree with the decline of their driving ability, yet feel a sense of loss, blame others, attempt to minimize and justify, and ultimately may feel depressed at the thought of giving up driving privileges. Driving is an earned privilege and in order to continue to drive safely, guidelines and regulations must be in place to evaluate and support older drivers.

Dementia and Driving Cessation

Alzheimer’s disease and driving safety is of particular concern to society. Alzheimer’s disease (AD) is the most common cause of dementia in later life and is a progressive and degenerative brain disease. In the process of driving, different regions of the brain cooperate to receive sensory information through vision and hearing, and a series of decisions are made instantly to successfully navigate. The progression of AD can be unpredictable and affect judgment, reasoning, reaction time and problem-solving. For those diagnosed with Alzheimer’s disease, it is not a matter of if retirement from driving will be necessary, but when. Is it any wonder that driving safety is compromised when changes are occurring in the brain? Where dementia is concerned, driving retirement is an inevitable endpoint for which active communication and planning among drivers, family, and health professionals are essential.

Current statistics from the Alzheimer’s Association indicate that 5.3 million Americans have Alzheimer’s disease (AD) and this number is expected to rise to 11-16 million by the year 2050. Many people in the very early stages of Alzheimer’s can continue to drive; however, they are at an increased risk and driving skills will predictably worsen over time. The Alzheimer’s Association’s position on driving and dementia supports a state licensing procedure that allows for added reporting by key individuals coupled with a fair, knowledgeable, medical review process.

Overall, the assessment of driving fitness in aging individuals, and especially those with dementia, is not clear cut and remains an emerging and evolving field today.

Physician’s Role in Driving Cessation

While most older drivers are safe, this population is more prone to vehicle accidents due to decreased senses, chronic illness and medication-related issues. The three primary functions that are necessary for driving and need to be evaluated are: vision, perception, and motor function. As the number of older drivers rises, patients and their families will increasingly turn to the physicians for guidance on safe driving. This partnership seems to be a key to more effective decision-making and the opinions of doctors vs. family are often valued by older drivers. Physicians are in a forefront position to address physical, sensory and cognitive changes in their aging patients. They can also help patients maintain mobility through proper counseling and referrals to driver evaluation programs. This referral may avoid unnecessary conflict when the doctor, family members or caregivers, and older drivers have differing opinions. (It should be noted that driver evaluation programs are usually not covered by insurance and may require an out-of-pocket cost.)

Not all doctors agree that they are the best source for making final decisions about driving. Physicians may not be able to detect driving problems based on office visits and physical examinations alone. Family members should work with doctors and share observations about driving behavior and health issues to help older adults limit their driving or stop driving altogether. Ultimately, counseling for driving retirement and identifying alternative methods of transportation should be discussed early on in the care process, prior to a crisis. Each state has an Area Agency on Aging program that can be contacted for information, and referrals can be made to a social worker or community agency that provides transportation services.

Resources do exist to help physicians assess older adults with memory impairments, weigh the legal and ethical responsibilities, broach the topic of driving retirement and move toward workable plans. The Hartford Insurance Corporation, for example, offers two free publications that make excellent patient handouts: At the Crossroads: A Guide to Alzheimer’s Disease, Dementia and Driving and We Need to Talk: Family Conversations with Older Drivers.

These resources reveal warning signs and offer practical tips, sound advice, communication starters, and planning forms. Other resources can be found through the Alzheimer’s Association. Physicians can also refer to the laws and reporting requirements for unsafe drivers in their state and work proactively with patients and their families or caregivers to achieve driving retirement before serious problems occur. Ultimately, assessing and counseling patients about their fitness to drive should be part of the medical practice for all patients as they age and face health changes.

Driver’s Role in Driving Cessation

“How will you know when it is time to stop driving?” was a question posed to older adults in a research study. Responses included “When the stress level from my driving gets high enough, I’ll probably throw my keys away” and “When you scare the living daylights out of yourself, that’s when it’s time to stop.” These responses are clues to a lack of insight and regard for the social responsibility of holding a driver’s license and the critical need for education, evaluation and planning.

Realizing one can no longer drive can lead to social isolation and a loss of personal or spousal independence, self-sufficiency, and even employment. In general, older drivers want to decide for themselves when to quit, a decision that often stems from the progression of medical conditions that affect vision, physical abilities, perceptions and, consequently, driving skills. There are many things that an older adult can do to be a safe driver and to participate in his or her own driving cessation.

The Centers for Disease Control and Prevention suggest that older adults:

  • Exercise regularly to increase strength and flexibility.
  • Limit driving only to daytime, low traffic, short radius, clear weather
  • Plan the safest route before driving and find well-lit streets, intersections with left turn arrows, and easy parking.
  • Ask the doctor or pharmacist to review medicines—both prescription and over-the counter—to reduce side effects and interactions.
  • Have eyes checked by an eye doctor at least once a year. Wear glasses and corrective lenses as required.
  • Preplan and consider alternative sources and costs for transportation and volunteer to be a passenger

Family’s or Caregiver’s Role in Driving Cessation

Initially, it may seem cruel to take an older person’s driving privilege away; however, genuine concern for older drivers means much more than simply crossing fingers in hopes that they will be safe behind the wheel. Families need to be vigilant about observing the driving behavior of older family members. One key question to be answered that gives rise to driving concerns is “Would you feel safe riding along with your older parent driving or having your child ride along with your parent?” If the answer is “no,” then the issue needs to be addressed openly and in a spirit of love and support. Taking an elder’s driving privileges away is not an easy decision and may need to be done in gradual steps. Offering rides, enlisting a volunteer driver program, experiencing public transportation together, encouraging vehicle storage during winter months, utilizing driver evaluation programs and other creative options, short of removing the keys, can be possible solutions during this time of transition.

Driving safety should be discussed long before driving becomes a problem. According to the Hartford Insurance survey, car accidents, near misses, dents in the vehicle and health changes all provide the chance to talk about driving skills. Early, occasional and honest conversations establish a pattern of open dialogue and can reinforce driving safety issues. Appealing to the love of children or grandchildren can instill the thought that their inability to drive safely could lead to the loss of an innocent life. Family members or caregivers can also form a united front with doctors and friends to help older drivers make the best driving decisions. If evaluations and suggestions have been made and no amount of rational discussion has convinced the senior to cease driving, then an anonymous report can be made to the Department of Motor Vehicles in each state.

According to the Alzheimer’s Association, strategies that may lead to driving cessation when less drastic measures fail include:

  1. Family meetings to discuss issues and concerns
  2. Disabling or removing the car
  3. Filing down the keys
  4. Placing an “Expired” sticker over the driver’s license
  5. Cancelling the vehicle registration
  6. Preventing the older driver from renewing his or her driver’s license
  7. Speaking with the driver’s doctor to write a prescription not to drive, or to schedule a formal driving assessment

Finally, it is suggested that family members learn about the warning signs of driving problems, assess independence vs. the public safety, observe the older driver behind the wheel or ride along, discuss concerns with a physician, and explore alternative transportation options. Solutions There are a multitude of solutions and recommendations that can be made in support of older drivers. Public education and awareness is at the forefront. An educational program that includes both classroom and on the road instruction can improve knowledge and enhance driving skills.

The AAA Foundation provides several safe driving Web sites with tools for seniors and their loved ones to assess the ability to continue driving safely.  These include AAAseniors.com and seniordrivers.org.  They also sponsor a series of Senior Driver Expos around the country where seniors and their loved ones can learn about senior driving and mobility challenges and have a hands-on opportunity to sample AAA’s suite of research-based senior driver resources. Information on the Expos is available at aaaseniors.com/seniordriverexpo.

AARP offers an excellent driver safety program that addresses defensive driving and age-related changes, and provides tools to help judge driving fitness. Expanding this program or even requiring participation seems to be a viable entry point for tackling the challenges of driving with the aging population.

CarFit is an educational program that helps older adults check how well their personal vehicles “fit” them and if the safety features are compatible with their physical characteristics. This includes height of the car seat, mirrors, head restraints, seat belts, and proper access to the pedals. CarFit events are scheduled throughout the country and a team of trained technicians and/or health professionals work with each participant to ensure their cars are properly adjusted for their comfort and safety.

Modification of driving policies to extend periods of safe driving is another solution. Older drivers nearing the end of their safe driving years could ‘retire’ from driving gradually, rather than ‘give up’ the driver’s license.  An older adult can be encouraged to relinquish the driver’s license and be issued a photo identification card at the local driver’s bureau.

The Alzheimer’s Association proposes several driving assessment and evaluation options. Among them are a vision screening by an optometrist, cognitive performance testing (CPT) by an occupational therapist, motor function screening by a physical or occupational therapist, and a behind the wheel assessment by a driver rehabilitation specialist. Poor performances on these types of tests have been correlated with poor driving outcomes in older adults, especially those with dementia. Requiring a driving test after a certain age to include both a written test and a road test may be an option considered by each state.  Finally, continued input and guidance will be necessary from AARP, state licensing programs, transportation planners, and policymakers to meet the needs of our aging driving population.

It is appropriate to regard driving as an earned privilege and independent skill that is subject to change in later life. In general, having an attitude of constant adjustment until an older individual has to face the actual moment of driving cessation seems to be a positive approach. Without recognizing the magnitude of this transition, improving the quality of life in old age will be compromised. Keeping our nation’s roads safe while supporting older drivers is a notable goal to set now and for the future.

 

Article from Today’s Caregiver.

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8 Early Parkinson’s Disease Symptoms That Are Too Easy to Miss

June 5, 2018 Education

This movement disorder is more treatable when caught early, but Parkinson’s disease symptoms can appear quite differently from one person to another. Talk to your doctor if you’re worried about any of these signs.

Changed handwriting

If your handwriting starts to go from big and loopy to small and cramped, this could be one of the earliest Parkinson’s disease symptoms. “Teachers with Parkinson’s will notice students complaining that they can’t read their handwriting when they write on the blackboard,” says Deborah Hall, MD, a neurologist at Rush University Medical Center in Chicago. Look for letters getting smaller and words crowding together. Many patients have slower movement and trouble with repetitive tasks, like handwriting.

Reduced sense of smell

If you’re having trouble smelling pungent foods or no longer pick up your favorite scents, see a doctor. It’s not the most common symptom of Parkinson’s, but Dr. Hall says patients who suffer a loss of smell report it being the earliest sign they experience. The link between reduced sense of smell and Parkinson’s isn’t clear, but one theory is that the clumps of the protein alpha-synuclein, found in the brains of all Parkinson’s patients, may form in the part of the brain responsible for smell before migrating to other areas and affecting motor function.

Trouble sleeping

If you were once a peaceful sleeper, but now toss and turn, flail your limbs, or even fall out of bed, those sleep problems could be Parkinson’s disease symptoms. It’s normal to have an occasional restless night, but talk to your doctor if you or your partner notices extra movement when you’re in a deep sleep, or if you start sleep-talking. More research is needed to discover why disturbed sleep and Parkinson’s are related, but one theory is that the degeneration of specific regions of the brain stem that can cause disordered sleeping may play a role in other Parkinson’s disease symptoms.

Constipation

If you’re not moving your bowels every day, or are increasingly straining, this can be an early sign of Parkinson’s. The disease alters the body’s autonomic nervous system, which controls processes like digestion and bowel function. Constipation on its own isn’t unusual, but if you’re experiencing other symptoms like difficulty sleeping and trouble moving or walking, talk to your doctor.

Depression

Much has been made of the link between the late comedian Robin Williams’ Parkinson’s diagnosis and ongoing battle with depression. Sometimes patients can develop depression after learning they have Parkinson’s, but it’s also common for people to be depressed years before they start to exhibit physical symptoms, says Michele Tagliati, MD, director of the Movement Disorders Program at Cedars-Sinai Medical Center in California. “Parkinson’s is characterized as a movement disorder because of a lack of dopamine in the brain, but there are also low levels of other neurotransmitters like serotonin, which are intimately related to depression,” he says. Parkinson’s patients who are depressed tend to feel apathetic and generally disinterested in things they used to enjoy, compared to feeling intensely sad or helpless, as is common in primary depression. “They lose pleasure in the simple things of life, like waking up in the morning and buying the paper,” says Dr. Tagliati. Treatment for depression includes counseling, antidepressant medication, and in the most extreme cases, electric shock therapy.

Tremors or shaking when relaxed

Shaking can be normal after lots of exercise or if you’re anxious, or as a side effect of some medications. But a slight shake in your finger, thumb, hand, chin, lip, or limbs when your body is at rest and your muscles are relaxed could signal Parkinson’s disease symptoms, according to the National Parkinson Foundation. About 70 percent of people with the disease experience a resting tremor, and it can become more noticeable during stress or excitement. These are the most common symptom and often tip people off to the disease, but when Parkinson’s patients think back they realize they experienced loss of smell, disturbed sleep, or anxiety before the tremors began.

Stiffness and slowed movements

Watch for an abnormal stiffness in your joints along with muscle weakness that doesn’t go away and makes everyday tasks like walking, teeth brushing, buttoning shirts, or cutting food difficult. If you no longer swing your arms when walking, your feet feel “stuck to the floor” (causing you to hesitate before taking a step), or people comment that you look stiff when you haven’t been injured, the National Parkinson Foundation suggests seeing a doctor.

Softer voice, or masked face

Doctors say that a softer voice or masked, expressionless face is a common sign of the disease. Some patients with Parkinson’s disease symptoms may also talk softer without noticing or have excessively fast speech or rapid stammering. Parkinson’s causes disruption of movement, including facial muscles.

Article from Reader’s Digest.

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