Dementia and Driving

There is no question that a person who gets lost when taking a walk should not be behind the wheel of a car and thus there is no question that a person with full blown dementia should not be driving. However it is tricky to say exactly when a person’s dementia has gotten to a point where it is no longer safe for them to drive. When in its early stages, dementia barely inhibits a person at all, and thus makes it no more dangerous for them to be behind a wheel than as with any other person. So when exactly is it that the license should be taken away… how do we tell, and how do we handle this situation with care?

Well I just read an amazing article that breaks it down into a 30 point scale which essentially says that any person that scores above a 26 on this scale is no longer fit to drive. Some of the credential on this scale is as follows:

• Clinical Dementia Rating Scale score 0.5 or higher (Level A)
• Caregiver rating of patient’s driving ability as marginal or unsafe (level B)
• Recent history of traffic citations (Level C)
• Recent history of accidents (Level C)
• Reduced driving mileage–less than 60 miles per week (Level C)
• Self-reported avoidance of driving situations (Level C)
• Minimental status scores of 24 or less (Level C)
• Aggressive/impulsive personality behaviors (Level C)

More on this subject can be found by reading the Evaluation and management of driving risk in dementia. Which can be found here:

http://www.neurology.org/cgi/content/abstract/74/16/1316

and by reading my source blog found here:

http://www.kevinmd.com/blog/2010/05/patients-dementia-stop-driving.html/comment-page-1#comment-134545

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Later, when the nurses were going through his meager possessions, they found this poem. Its quality and content so impressed the
staff that copies were made and distributed to every nurse in the hospital. One nurse took her copy to Missouri. The old man’s sole bequest to posterity has since appeared in the Christmas edition of the News Magazine of the St. Louis Association for Mental Health. A slide presentation has also been made based on his simple, but eloquent, poem.

And this little old man, with nothing left to give to the world,
is now the author of this ‘anonymous’ poem winging across the Internet.

Crabby Old Man

What do you see nurses? . . . .. . What do you see?
What are you thinking . . . . . When you’re looking at me?
A crabby old man .. . . . . Not very wise,
Uncertain of habit . . . . . With faraway eyes?

Who dribbles his food . . . . . And makes no reply.
When you say in a loud voice . . . . . ‘I do wish you’d try!’
Who seems not to notice . . . . . The things that you do.
And forever is losing . . . . . A sock or shoe?

Who, resisting or not . . . . . Lets you do as you will,
With bathing and feeding . . . . . The long day to fill?
Is that what you’re thinking? . . . . . Is that what you see?
Then open your eyes, nurse . . . . . You’re not looking at me.

I’ll tell you who I am. . … . . . As I sit here so still,
As I do at your bidding, . . . . . As I eat at your will.
I’m a small child of Ten . . . . . With a father and mother,
Brothers and sisters . . . . . Who love one another.

A young boy of Sixteen . . . . With wings on his feet.
Dreaming that soon now . . . . . A lover he’ll meet.
A groom soon at Twenty . . . . . My heart gives a leap.
Remembering, the vows . . . . . That I promised to keep.

At Twenty-Five, now . . . . . I have young of my own.
Who need me to guide . . . . . And a secure happy home.
A man of Thirty . … . . . My young now grown fast,
Bound to each other . . . . . With ties that should last.

At Forty, my young sons . . . . . Have grown and are gone,
But my woman’s beside me . . . . . To see I don’t mourn.
At Fifty, once more, babies play ’round my knee,
Again, we know children . . . . . My loved one and me.

Dark days are upon me . . . . . My wife is now dead.
I look at the future . . . . . Shudder with dread.
For my young are all rearing . . . . . Young of their own.
And I think of the years . . . . . And the love that I’ve known.

I’m now an old man … . . . . And nature is cruel.
Tis jest to make old age . . . .. . Look like a fool.
The body, it crumbles . . . . . Grace and vigor, depart.
There is now a stone . .. . . Where I once had a heart.

But inside this old carcass . . . . . A young guy still dwells,
And now and again . . . . . My battered heart swells.
I remember the joys . . . . . I remember the pain.
And I’m loving and living . . . . . Life over again.

I think of the years, all too few . . . . . Gone too fast.
And accept the stark fact . . . . That nothing can last.
So open your eyes, people . . . . . Open and see.
Not a crabby old man . . . Look closer . . . See ME!!

Remember this poem when you next meet

An older person who you might brush aside

Without looking at the young soul within.

We will all, one day, be there, too!

Last month in the Heart Letter , we looked at how emotions, isolation, and a host of other psychological and social factors affect the heart.  It works the other way, too:  The health of your heart and blood vessels affects your mind and brain.

One of the hazards of living longer is the specter of Alzheimer’s disease.  This thief of memory is relatively uncommon before age 60, but then increases with each passing half-decade, eventually afflicting just under half of those over age 85.
Numbers like these make it look as though losing your memory is part of normal aging.  It isn’t. There is growing evidence that you might be able to prevent it, or at least push it back, with the same steps that help protect you from a heart attack or stroke.

Types of memory loss
The term dementia is an umbrella for damage to the brain that leads to memory loss, confusion, and changes in personality or speech. This damage can arise from a variety of causes, including head injury, malnutrition, and disease. Among older people, the most common causes are Alzheimer’s disease and vascular dementia.
Alzheimer’s is a progressive degeneration of the brain. Tangled strands of hairlike protein accumulate inside brain cells. Outside, clumps of a protein called beta-amyloid and debris from broken-down brain cells cluster around the connections between brain cells. The protein tangles and clumps kill brain cells and make it difficult for them to communicate with one another, leading to loss of memory, confusion, and other changes.
Degeneration is also a hallmark of vascular dementia. In this case it arises because lack of oxygen kills cells in one or more sections of the brain. This happens when small strokes disrupt blood flow or narrowed arteries seriously restrict it.
Some people have only Alzheimer’s disease, and some have only vascular dementia. But about half of those with memory loss and other symptoms have both.

Common pathways
Research suggests that similar scenarios – involving cholesterol-clogged arteries, inflammation, and risk factors for heart disease and stroke – contribute to both Alzheimer’s disease and vascular dementia.
Restricted blood flow in the brain may contribute to the cascade of events that leads to the tangles and clumps of Alzheimer’s. Deposits of beta-amyloid in blood vessels supplying the brain make them more fragile and likely to burst, which would cause a hemorrhagic stroke.
Some people develop the tangles and clumps associated with Alzheimer’s without showing signs of dementia. Autopsies show that memory loss and changes in thinking skills and personality are more likely to have occurred when tangles and clumps are accompanied by signs of strokes and restricted blood flow in the brain.
In other words, improving blood flow to the brain and working to prevent strokes may maintain memory well into old age.

Reverse the curse
A handful of studies link harmful habits or health issues in midlife with memory loss or declining thinking skills later on. In a 2005 report in the journal Neurology, researchers with a large California HMO found that 40-year-olds with four common cardiovascular risk factors – high cholesterol, high blood pressure, diabetes, and smoking – were more than twice as likely to develop dementia as those with none of these factors. In a more positive light, there’s growing evidence that healthful habits and changes are good for the brain and the mind.

Exercise. Walk, run, swim, cycle, garden, dance – better yet, do them all – to keep both brain and body in shape. Long-term regular physical activity has been linked with better cognitive function and less aging-related decline. A report from the Cardiovascular Health Cognition Study suggests that the variety of exercise, not just how much or how hard you exercise, may help ward off dementia. Exercise also looks like a way to prevent, and even treat, depression.
Blood pressure. Untreated high blood pressure speeds aging-related decay in thinking skills and memory. Pressure-lowering drugs may help, although it isn’t clear if one kind is better than another.
Dietary fat. Eating a lot of saturated and trans fat may promote dementia, while omega-3 fats may protect against the buildup of sticky beta-amyloid clumps in the brain. Omega-3 fats may also be a good way to prevent depression. Good sources of these healthful fats include salmon, mackerel, and other cold-water fish, as well as plant sources such as walnuts, canola oil, and flaxseed.
Cholesterol-lowering statins. A few studies suggest that people who take a statin (Lipitor, Zocor, generic lovastatin, etc.) are less likely to develop Alzheimer’s disease than those who don’t take this type of drug. If true, this would be an important “side effect” of statins, which are popular medications for fighting heart disease. At the same time, reports of statin-associated memory loss have appeared in medical journals.

Taking control
The intersection of cardiovascular health and brain health is a relatively new field of research. So far there are tantalizing hints – but no guarantees – that doing what you can to keep your heart and blood vessels in good shape will do the same thing for your brain and your mind.

It’s a gamble worth taking.
 

 

 

Brain Matters Research

4723 West Atlantic Avenue
Delray Beach, Florida 33445
Phone: 1-888-739-7974

Is it appropriate to include Alzheimer’s disease patients in non-AD clinical research?
Dr. Yaari, associate director of the Memory Disorders Clinic at Banner Alzheimer’s Institute, Phoenix, Ariz.

Investigation studies for novel compounds treating Alzheimer’s disease (AD) require participation of people with the condition.  Although some patients with early AD have capacity to provide their own informed consent, the majority of patients with AD have impaired decisional capacity requiring a surrogate to provide consent.  It is common practice in AD studies to obtain consent from a legally authorized representative, usually a close relative, and an asset from the patient.  Although imperfect, guidelines and processes have been developed to allow persons with diminished decision-making capacity due to AD to participate in clinical trials focused on treatments for AD.

Participation in clinical trials provides numerous benefits to AD patients and their families, and in addition to current practice guidelines for AD, should be routinely offered as standard care.  A clinical trial can provide a novel therapy for AD that may improve a patient’s condition, but these patients will suffer from co morbid medical conditions that often have a negative impact on cognitive functioning, quality of life of their caregiver.  Clinical trials for conditions such as hypertension, hypercholesterolemia, and diabetes, just to name a few, can certainly benefit from including AD patients by aiding enrollment and improving the generalizablity and safety of the treatment.  However, some compounds or procedures in clinical trials should exclude persons with AD if there is a significant risk of worsening the patient’s condition.

During the course of a study, patients receive close (and free) medical monitoring in addition to social, educational, and behavioral support and problem solving that is typically not otherwise available.  Most importantly, clinical trial participation provides not only hope, but an authentic sense of purpose that their efforts are a part of a larger picture in finding therapies that will help people in the future.

Given that therapeutic trials in AD have proven the feasibility of conducting a trial in this population in terms of medication adherence, reporting of adverse events, and obtaining metrics of the treatment’s effectiveness, then in general, there should be no reason to exclude persons with AD from non-AD treatment trials so long as the patient has a reliable care partner and study partner.

Brain-Matters-Research-Mark-Brody
Alzheimer’s Clinical Research in Florida

4723 West Atlantic Avenue
Delray Beach, Florida 33445
Phone: 1-888-739-7974