Estate Planning Blog Articles

Estate & Business Planning Law Firm Serving the Providence & Cranston, RI Areas

Tips for Caregiving during the Pandemic

The Harvard Health Letter provides some great tips in its recent article entitled “Caregiving during the pandemic” to make certain that a loved one is receiving the best care.

Direct Communication. If your elderly family member can communicate well, talk to them daily and remember that when you ask basic questions like “How are you feeling?” “Are you eating and drinking enough?” “Are you getting enough sleep?” However, that you may not get a straight answer. They may just tell you what you want to hear. Therefore, try to get a more realistic picture. Listen to how they sound on the call, and see if they sound different, sad, confused, or tired. Ask them how they’ve been spending their time and who they’ve seen that day. Look for clues that they may be getting sick.

Speak with The Staff. Ask questions. Start with the director of nursing or a caseworker. You can tell the staff you’re worried and that you may be asking more questions than usual. Find out how often they’re able to give you updates and have a list of questions that includes the following aspects of your loved one’s health and well-being.

  • Socialization. Ask if your family member is participating in activities or just staying in their room most of the time. If they’re not getting out, ask about a plan to get them back into a healthy social and physical routine.
  • Does the staff feel your senior is in generally good spirits, or is there an issue? Is this impacting their health or daily activities?
  • Physical Strength. Is your parent having difficulty rising from a chair or feeling unsteady when walking? Inactivity can diminish muscle strength and cause falls. Get them into an exercise routine or physical therapy.
  • Eating Habits. Are they eating and drinking enough, and what is the staff doing to encourage nutrition and hydration? A change in eating and drinking habits can mean a change in mood and should be addressed by a doctor.
  • Have any medications been added or eliminated recently, and for what reason?
  • Continence. Ask if your senior is able to get to the bathroom on time. If they’re incontinent, what’s the plan to deal with this issue?
  • Hygiene. Is your elderly loved one is able to bathe, brush his or her teeth and do other bathroom activities? If not, ask how often the staff is providing assistance.
  • Cognitive Skills. Ask if there’s been any change in your loved one’s ability to reason or have a conversation. In some cases, it might be linked to something fixable, like medication side effects or a urinary tract infection.

If You Find an Issue. Inform the staff about your concerns, especially if you suspect a new problem. Arrange a visit with a physician and try to be on the call if possible.

Social interaction is also important, so encourage loved ones to take part in activities at their facility. In the same fashion, try to connect with your loved one in any way possible. Make frequent visits if they’re allowed, drop off a care package, a card, flowers, or a picture from a grandchild. This is the best way to stave off feelings of isolation and loneliness that so many people in facilities experience.

Reference: Harvard Health Letter (March 2021) “Caregiving during the pandemic”

Does Blackjack Keep My Brain Sharp?

People who regularly play non-digital games, like card or board games, have been found to do better on memory and thinking tests in their 70s than those who don’t.

That’s according to a recent study from the University of Edinburgh in Scotland.

The Money Talk News article from April 2020 entitled “This Pastime Can Keep Your Brain Sharp as You Age” reports that there’s even better news: Those who suddenly increased game playing during their 70s also were more likely to maintain certain cognitive skills.

So, break out Monopoly or get some people together to play bridge or blackjack!

For the long-term study, which was published in The Journals of Gerontology, psychologists tested more than 1,000 people born in 1936 beginning at age 70 in skills such as memory, problem-solving, thinking speed and general thinking ability.

Researchers repeated the tests every three years, until the study participants were 79. At two ages — 70 and 76 — the participants also reported how frequently they played non-digital games, such as bingo, cards, chess or crosswords.

Those who played more games later in life saw less decline in thinking skills from age 70 to 79.

This protective effect was especially evident in memory function and thinking speed.

The researchers at the University of Edinburgh in Scotland noted that their findings were just the latest in a collection of evidence that supports a connection between engaging in activities throughout life and better thinking ability in old age.

In a university announcement about the study, co-author Ian Deary says:

“It would be good to find out if some of these games are more potent than others. We also point out that several other things are related to better cognitive aging, such as being physically fit and not smoking.”

So, chess anyone?

Reference: Money Talk News (April 23, 2020) “This Pastime Can Keep Your Brain Sharp as You Age”

 

How will an Apple Watch Help Study Dementia?

AI’s recent article entitled “Biogen will use Apple Watch to study symptoms of dementia,” says that this study will last for multiple years, and will launch later this year. People from a wide gamut of ages and cognitive performance levels will be asked to take part by Biogen.

They hope to find out if wearable devices like the Apple Watch could be used for long-term cognitive performance monitoring.

The ultimate objective is to develop digital biomarkers for cognitive performance monitoring over time, which may help identify early signs of mild cognitive impairment (MCI).

There are now serious delays in recognizing declines in cognitive health. This impacts about 15 to 20% of adults over the age of 65. The subtle onset of symptoms, including being easily distracted and memory loss, may take months or even years before it is observed as a cognitive decline by healthcare providers.

“The successful development of digital biomarkers in brain health would help address the significant need to accelerate patient diagnoses and empower physicians and individuals to take timely action,” said Biogen CEO Michel Vounatsos. “For healthcare systems, such advancements in cognitive biomarkers from large-scale studies could contribute significantly to prevention and better population-based health outcomes, and lower costs to health systems.”

Apple believes that this study “can help the medical community better understand a person’s cognitive performance, by simply having them engage with their Apple Watch and iPhone,” said Apple COO Jeff Williams. “We’re looking forward to learning about the impact our technology can have in delivering better health outcomes through improved detection of declining cognitive health,” he said.

The Apple Watch has been used for a number of health studies in the past, which are done with the research app. There have been studies to detect heart issues before they become an issue, as well as a hearing study monitoring ambient sound volumes, and activity and movement.

The dementia study is designed to ensure consumer privacy, control and transparency. It will emphasize data security.

The participants must complete a detailed consent from listing the collected data types and how they are used and shared before taking part. They can withdraw at any time.

Reference: AI (Jan. 11, 2021) “Biogen will use Apple Watch to study symptoms of dementia”

Is there a Blood Test for Alzheimer’s?

Independent experts are cautious of a new first blood test to help diagnose Alzheimer’s disease due to the fact that key test results haven’t been published, and the test has not been approved by the FDA. While it’s being sold under more general rules for commercial labs, they agree that a simple test that can be performed in a doctor’s office is long overdue.

NBC News’s recent article entitled “First blood test to help diagnose Alzheimer’s goes on sale” notes that more than five million people in the U.S. and millions more around the world have Alzheimer’s, the most common form of dementia. To be diagnosed with it, people will experience symptoms, such as memory loss plus evidence of a buildup of a protein in the brain called beta-amyloid.

Currently, the best way to measure beta-amyloid is a costly PET brain scan that usually is not covered by insurance. As a result, most people won’t get one and are left wondering if their problems are due to normal aging, Alzheimer’s, or another cause. However, this new blood test from C2N Diagnostics in St. Louis will try to fill that gap. The test isn’t designed for general screening or for people without symptoms. It is intended for those 60 and older, who are having thinking problems and are being evaluated for Alzheimer’s.

The test isn’t covered by insurance or Medicare, and C2N Diagnostics charges $1,250. However, it offers discounts based on income. Only a physician can order the test, and results come within 10 days. It’s sold in all but a handful of states in the U.S. and was just approved for sale in Europe.

The blood test measures two types of amyloid particles plus various forms of a protein that show if a person has a gene that increases risk for the disease. These factors are combined in a formula that includes age, and patients are given a score suggesting low, medium or high likelihood of having amyloid buildup in the brain. If the test scores the patient in the low category, it’s a good reason to look for other things besides Alzheimer’s. There are a number of things that can cause a person to be cognitively impaired, from vitamin deficiencies to medications.

The company has not published any data on the test’s accuracy, but the doctors have published on the amyloid research leading to the test. Company materials cite results comparing the test to PET brain scans, which is the current gold standard, in 686 people, ages 60-91, with cognitive impairment or dementia. If a PET scan showed amyloid buildup, the blood test also gave a high probability of that in 92% of cases and missed 8% of them, said the company’s CEO, Dr. Joel Braunstein. If the PET scan was negative, the blood test ruled out amyloid buildup 77% of the time. The other 23% got a positive result, but that doesn’t necessarily mean the blood test was wrong. The published research suggests it may see amyloid buildup before it’s noticeable on scans.

Braunstein said the company will seek FDA approval, and the agency has designated it for a faster review.

Reference: NBC News  (Nov. 30, 2020) “First blood test to help diagnose Alzheimer’s goes on sale”

sean connery dementia

Scottish Actor Sean Connery May Have Had Dementia

The famous screen actor, Sean Connery, who was famous for portraying the original on-screen James Bond, passed away at his home in the Bahamas.

Yahoo News’s recent article entitled “Sean Connery widow reveals he had suffered from dementia” reported that Connery died peacefully in his sleep surrounded by family members, according to his widow Micheline Roquebrune.

“I was with him all the time and he just slipped away,” the 91-year-old told the London Daily Mail.

“He had dementia and it took its toll on him. He got his final wish to slip away without any fuss. It was no life for him. He was not able to express himself lately.”

Connery will be remembered at a private funeral ceremony, with a memorial event to be held later, according to a publicist. He was knighted in 2000 and won many awards during his decades-spanning career, including an Oscar, three Golden Globes and two Bafta awards.

However, it was his smooth, Scottish-accented portrayal of the suave licensed-to-kill spy 007 that earned him lasting worldwide fame and adoration. He was the first actor to say the unforgettable “Bond, James Bond.”

He made six official films as novelist Ian Fleming’s spy, giving what many still consider to be the definitive portrayal.

Former 007 actor Pierce Brosnan joined the flood of weekend tributes to the Scottish actor, who he said, “led the way for us all who followed in your iconic footsteps.”

“You were my greatest James Bond as a boy, and as a man who became James Bond himself, you cast a long shadow of cinematic splendor that will live on forever,” Brosnan added.

Connery was born in Edinburgh in 1930. He married French artist Roquebrune in 1974 after they met in Morocco in 1970.

They lived outside his native Britain for decades, previously owning a home in the Spanish resort of Marbella and then in the Bahamas.

“He was gorgeous, and we had a wonderful life together,” the Tunisian-born widow said. “He was a model of a man. It is going to be very hard without him. I know that. But it could not last forever and he went peacefully.”

Reference: Yahoo News (Nov. 1, 2020) “Sean Connery widow reveals he had suffered from dementia”

polar bear plunge and dementia

Could a Polar Bear Plunge Help with Dementia?

A “cold-shock” protein has been discovered in the blood of regular winter swimmers at London’s Parliament Hill Lido. The protein has been shown to retard the onset of dementia and even repair some of the damage it causes in mice, according to a report in the BBC’s recent article entitled “Could cold water hold a clue to a dementia cure?”

Professor Giovanna Mallucci, who runs the United Kingdom Dementia Research Institute’s Centre at the University of Cambridge, says the discovery could help scientists with new drug treatments that may help hold dementia at bay. The research, while encouraging, is at an early stage and focuses on the hibernation ability that all mammals retain, which is prompted by exposure to cold.

The link with dementia lies in the destruction and creation of synapses, which are the connections between cells in the brain. In the early stages of Alzheimer’s and other neuro-degenerative diseases, these brain connections are lost. Mallucci saw that brain connections are lost when hibernating animals, like bears, bed down for their winter sleep, but that roughly 20-30% of their synapses are culled as their bodies preserve precious resources for winter. When they awake in the spring, those connections are reformed.

The shock of entering cold water results in a significant increase in heart rate and blood pressure, which can cause heart attacks and strokes in those with underlying illnesses. This also creates a gasp reflex and rapid breathing, which can lead to drowning, if water is inhaled.

Don’t try a plunge without consulting a doctor.

When researching this treatment in mice, scientists found that levels of a “cold-shock” protein called RBM3 soared in the ordinary mice, but not in the others. This suggested RBM3 could be the key to the formation of new connections. Mallucci proved the link in a separate experiment which showed brain cell deaths in Alzheimer’s and prion disease could be prevented by artificially boosting RBM3 levels in mice. This was a major breakthrough in dementia research, and their findings were published in the scientific journal Nature.

Professor Mallucci contends that a drug which prompted the production of RBM3 might help slow—and possibly even partially reverse—the progress of some neuro-degenerative diseases in people. RBM3 hadn’t been seen in human blood, so the obvious next step was to find out whether the protein is present in humans.

It’s hard to get people to become hypothermic by choice, but Martin Pate and his group of Londoners who swim throughout the winter at the unheated open-air London Parliament Hill Lido pool voluntarily made themselves hypothermic on a regular basis, so he thought they’d be ideal subjects of a study.

The tests showed that a significant number of the swimmers had markedly elevated levels of RBM3. All of them become hypothermic, with core temperatures as low as 93.2F. A control group of Tai Chi participants who practice beside the pool but never actually swim, showed no increase in RBM3 levels nor had they experienced very low body temperatures.

The risks associated with getting cold outweigh any potential benefits, so cold water immersion isn’t a potential dementia treatment. The key is to find a drug that stimulates the production of the protein in humans and to show that it really does help delay dementia.

Reference: BBC (Oct. 19, 2020) “Could cold water hold a clue to a dementia cure?”

dementia

Baseball Champion Sues Daughter-In-Law, denies having Dementia

Eighty-two-year-old Giants great Orlando Cepeda filed a lawsuit against his daughter-in-law Camille Cepeda alleging elder financial abuse, fraud and infliction of emotional distress, as reported in the article “Giants great Orlando Cepeda denies having dementia, sues daughter-in-law for fraud” from the San Francisco Chronicle. He also accused her of negligence in handling his finances, after giving her power of attorney in 2018.

Cepeda accuses Camille of spending his money on personal expenses, including lease payments on a $62,000 Lexus, a Louis Vuitton handbag, expensive wine and taking out at least $24,000 in cash from his accounts. It also claims that she has placed all of his baseball memorabilia in a storage locker and will not give him the key or the location of the locker. That includes his National League Most Valuable Player trophy, which he wants back.

This is the latest news from a dispute that began after the Hall of Famer married his second wife, Nydia. They had two of Cepeda’s four sons, including Ali Cepeda, who is married to Camille. The parents are now not speaking to their son, and some of the brothers, four in total, have taken sides and are not speaking to each other.

Cepeda granted his daughter-in-law power of attorney in April 2018, two months after he suffered a heart attack and irreversible brain damage caused by oxygen deprivation. She was to have access to his accounts and pay his bills. Before the heart attack, she had handled his financial and business affairs.

On May 29, Camille filed a petition with the court seeking conservatorship of Cepeda, stating that he has dementia and cannot make his own financial decisions. Two of Cepeda’s sons, including Camille’s husband Ali, filed papers supporting her petition.

In Cepeda’s response, he cited two neuropsychological reports, including one done in May, that declared that he was fit to make his own medical decisions and understands all but the most complex financial issues. Cepeda says that his daughter-in-law filed for conservatorship to cover up the fraud that he is alleging in the lawsuit. He says that he does not need a conservator, and if anyone should have that role, it would be his wife Nydia.

The lawsuit filed by Cepeda offers a glimpse into why he believes she wants conservatorship, saying he doesn’t have the capacity to understand the nature and consequences of his remarriage, nor his decision to remove Camille as power of attorney and grant it to Nydia.

The suit alleges that Camille was opposed to the marriage from the start and even suggested they stage a fake ceremony that would not be legally sanctioned.

Cepeda’s lawsuit seeks damages, legal fees and demands that Camille return his memorabilia and all financial records she has allegedly refused to provide to account for how she handed his money. The suit also cites a $62,000 withdrawal to pay Cepeda’s tax bill, which was not actually paid. The filing says she was negotiating with the IRS, but she will not provide the documentation that he needs to settle with the government. Nor did she pay a medical bill for $6,800, although she did cash a check from the insurance company that was sent to pay for it.

Cepeda remains hopeful that the entire matter may be settled, before the case returns to court.

“It’s very painful,” Cepeda told a reporter. “I love my family. I love my kids. But this is life. You have to do what you have to do.”

Reference: San Francisco Chronicle (June 26, 2020) “Giants great Orlando Cepeda denies having dementia, sues daughter-in-law for fraud”

bad thoughts and dementia

Can Bad Thoughts Bring on Dementia?

There is recent research that has shown a link between repeated patterns of repetitive negative thinking (RNT) and signs of dementia. This study suggests a link between the key signs of dementia, the buildup of proteins in the brain and cognitive decline, and RNT.

Medical News Today reported in its recent article entitled “Link between dementia and repetitive negative thinking identified” that this study was published in the journal Alzheimer’s & Dementia. The study set forth the foundation for future research to consider how the link may function, and if psychological therapies that treat RNT can inhibit Alzheimer’s and other dementias.

The CDC explains that dementia is a term that represents a variety of diseases characterized by cognitive decline, which includes trouble remembering, thinking or making decisions that adversely affect a person’s everyday life.

The most common type of dementia is Alzheimer’s disease. This is a degenerative disease, which means it worsens over time. It’s not yet known exactly what causes Alzheimer’s disease. The CDC says that there are likely several factors involved. There is currently no cure for Alzheimer’s.

Prior research has suggested that psychological factors, like depression and anxiety, may also have a connection to Alzheimer’s. This has led researchers to develop the concept of cognitive debt as a risk factor for Alzheimer’s disease, which they believe is acquired by RNT. A large part of RNT are processes of rumination — repeatedly thinking about the past — and worry, being concerned about the future.

The research examined the participants’ RNT, depression, anxiety and cognitive decline levels for up to four years. They also measured the levels of tau and amyloid proteins in the brains of 113 of the participants. Scientists think that the buildup of these structures is key to the development of Alzheimer’s.

The authors of the new research discovered that the higher a person’s RNT, the faster their cognitive decline. They also found these people were more likely to have significant deposits of tau and amyloid proteins. However, although the research found a link between depression and anxiety and cognitive decline, they did not find a connection between depression and anxiety and the buildup of tau and amyloid proteins.

According to the lead author of the study Dr. Natalie Marchant of University College, London, United Kingdom, “[d]epression and anxiety in mid-life and old age are already known to be risk factors for dementia. Here, we found that certain thinking patterns implicated in depression and anxiety could be an underlying reason why people with those disorders are more likely to develop dementia.

“Taken alongside other studies that link depression and anxiety with dementia risk, we expect that chronic negative thinking patterns over a long period of time could increase the risk of dementia. We do not think the evidence suggests that short-term setbacks would increase one’s risk of dementia.

“We hope that our findings could be used to develop strategies to lower people’s risk of dementia, by helping them to reduce their negative thinking patterns.”

The study’s authors say that it’s probable that RNT contributes to Alzheimer’s in some way, possibly elevating an individual’s stress levels. However, they couldn’t discount the possibility that early signs of Alzheimer’s could lead to RNT.

Reference:  Medical News Today (June 11, 2020) “Link between dementia and repetitive negative thinking identified”

exercise and dementia

Can Exercise Help with Dementia?

A new study shows that even when your memory starts to fade, you can still do something about it by adding aerobic exercise to your lifestyle, reports News Atlas’ recent article entitled “Aerobic exercise shown to improve memory in those at risk of dementia.”

The study concentrated on the long-term changes to cerebral blood flow that comes from aerobic exercise in patients already presenting with age-related mild cognitive impairment. Thirty subjects with an average age of 66 who did not regularly exercise but had signs of memory impairment were divided into two groups.

One group was asked to do several aerobic exercise sessions each week for 12 months, and the other group performed stretch and balance sessions aimed at strengthening their upper and lower body while keeping heart rates low. MRI scans calculated cerebral blood flow in all participants at the beginning and end of the year-long study.

After a year, the aerobic exercise group showed increased cerebral blood flow to the anterior cingulate cortex and adjacent prefrontal cortex, relative to the stretching group. Memory tests conducted at the start and end of the study also showed a 47% improvement in the aerobic group, while the stretching group had only minimal improvements. The study suggests a direct correlation between improvement on the memory test scores and increases in cerebral blood flow to these key areas of the brain.

While the number of people studied was small, the results are consistent with a large volume of prior research affirming the value of exercise in maintaining cognitive abilities in older age. Aerobic exercise appears to confer the greatest cognitive protections, especially in those most at risk of Alzheimer’s disease.

The researchers note that the group of patients that were recruited in the study all reported little to no regular exercise prior to the trial. The novelty of this particular trial is that it offers signs that aerobic exercise can confer cognitive benefits, even when started at an advanced age, after memory decline has already started, and those cognitive benefits may be mediated specifically by improved blood flow to specific regions of the brain.

The study was published in The Journal of Alzheimer’s Disease.

Reference: News Atlas (May 24, 2020) “Aerobic exercise shown to improve memory in those at risk of dementia”