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Caring for the Caregiver

A lifestyle intervention for those caring for patients with dementia

By Yani Lu, MD, Ph.D.

Today, more than 5 million Americans are living with Alzheimer’s disease. A new case of Alzheimer’s disease is diagnosed every 66 seconds. By mid-century, the number of people living with Alzheimer’s disease in the United States is projected to grow to 13.8 million. Between 2000 and 2013, deaths resulting from stroke, heart disease, and prostate cancer decreased 23%, 14%, and 11%, respectively, whereas deaths from Alzheimer’s disease increased 71%, making it the sixth leading cause of death in the United States and the fifth leading cause of death in Americans aged 65 years or older. One in 3 seniors dies with Alzheimer’s or another dementia.

With the exception of Alzheimer’s disease caused by genetic abnormalities, which account for 1% or less of all Alzheimer’s disease cases, it is believed that Alzheimer’s disease, like other common chronic diseases, develops as a result of multiple factors rather than a single cause. The greatest risk factors for late-onset “sporadic” Alzheimer’s disease are older age, having a family history of Alzheimer’s disease and carrying the APOE E4 gene. However, Alzheimer’s disease is not a normal part of aging, and the increased risk associated with having a family history of Alzheimer’s disease is not entirely explained by whether the individual has inherited the APOE E4 risk gene.

In recent years, numerous reports have highlighted the strong relationship between dementia and metabolic disorders, in which brain glucose utilization and energy production are impaired. Alzheimer’s disease has been considered to be type 3 diabetes, a form of brain diabetes that has elements of both insulin resistance and insulin deficiency, even in patients without type 1 or type 2 diabetes. Evidence from most recent studies strongly suggests that several modifiable risk factors reduce risk for cognitive decline and may reduce the risk of dementia; these mainly include a healthy diet, physical activity, lifelong learning/cognitive training, and management of cardiovascular risk factors (especially diabetes, obesity, smoking, and hypertension). Bredesen, et al., recently demonstrated the reversal of cognitive decline in patients with early Alzheimer’s disease by utilizing multiple modalities designed to achieve metabolic enhancement for neurodegeneration.

Although the results from recent studies that involve healthy diet and lifestyle changes are promising, the proposed interventions are challenging to implement and prove difficult to adhere to for patients with dementia who lack strong caregiver support. In 2015, more than 15 million family members and other unpaid caregivers provided an estimated 18.1 billion hours of unpaid care valued at more than $221 billion to people with Alzheimer’s and other dementias. The costs of Alzheimer’s care may place a substantial financial burden on families. It has been shown that nearly half of care contributors cut back on their own expenses (including food, transportation and medical care) to pay for dementia-related care of family member or friend.

Compared to caregivers of people without dementia, caregivers of people with dementia tend to provide more extensive assistance, provide care for a longer time, and are twice as likely to experience financial, emotional and physical difficulties. Approximately 40% of family caregivers of people with dementia suffer from depression, compared with 5-17% of non-caregivers of similar ages; rates of depression increase with the severity of cognitive impairment of the person with dementia. Several studies show these caregivers also experience more sleep disturbance, higher degrees of physical strain, and a higher likelihood of elevated biomarkers of cardiovascular disease risk and impaired kidney function risk, which may lead to their higher risk of dying compared to caregivers of non-dementia patients. The etiology of all these health issues is likely from the combination of stress, high intensity of caregiving, and shared diet and lifestyle factors.

A team of doctors and staff from the Eisenhower Medical Center and the Eisenhower Memory Care Center are working together to initiate a new approach to help caregivers and their loved one with dementia. We will teach caregivers to establish good coping techniques to improve emotional well-being and to establish healthy lifestyles to improve physical health. This new approach actively involves caregivers, is tailored to meet their daily challenges, and will significantly benefit their loved one with dementia. Specifically, on a weekly basis, caregivers are offered a ninety-minute therapeutic yoga/meditation class and a series of lectures focusing on diet, deep breathing, meditation, physical activity, sleep, and updated knowledge in dementia prevention and treatment. To increase compliance, the diet intervention is designed to benefit both the health of caregivers as well as their loved ones with dementia. Improving caregivers’ diets will carry over and change the diet of patients with dementia as the caregivers generally manage all aspects of the diet, including grocery shopping and meal preparation.

It is our hope that after completing this intervention, family caregivers will have improved health status and improved coping skills for daily caregiving duties. Encouraged by their own benefit from this intervention program, caregivers will be more motivated to become actively involved in implementing dietary and lifestyle changes for their loved ones with dementia to help them fight this chronic, life-long disease.

The success of this community intervention will provide a new approach in which we can apply diet and lifestyle changes to other community caregivers such as those caring for alcoholism, patients with HIV, cancer, multiple sclerosis, as well as Eisenhower employees and other community organizations. By implementing lifestyle changes among caregivers, their loved ones with specific health problems, other family members and friends also benefit. We hope to see an improved emotional health and quality of life within our whole society.

Team members for this community intervention program include Dr. Yani Lu, FM resident at EMC; Denise Latini, Manager of Memory Care Center; Dr. Joseph Scherger; Dr. Kenneth Thrasher and Dr. Kulwinder Fayssoux. With appreciation of the Family Medicine Resident Program at EMC; Eisenhower Wellness Center; Eisenhower IRB committee; Dr. Farhad Limonadi; Dr. Alfred Shen; Dr. Barry Hackshaw; Dr. Kiran Dintyala; and Dr. Michael Del Rosario. For more information contact the Eisenhower Memory Care Center at (760) 836.0232.

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