Estate Planning Blog Articles

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Does Air Pollution Cause Alzheimer’s Disease?

The air quality study was released by the Alzheimer’s Association.

Researchers monitored two groups of at-risk adults, one in Europe and the other in the U.S., over a 10-year period.

WTOP’s article entitled “Study: New evidence shows link between air pollution, Alzheimer’s disease” reports that Dr. Heather Snyder, the vice president of Medical and Scientific Relations at the association, commented that those in Europe who were in less-polluted areas saw a drop in risk by 15% for dementia and 17% for Alzheimer’s disease.

More than six million Americans are living with Alzheimer’s. By the year 2050, this number is expected to increase to nearly 13 million.

The Alzheimer’s Association reports that one in three seniors dies with Alzheimer’s or another dementia. It kills more people than breast cancer and prostate cancer combined.

Women in the U.S. who participated in the study saw a 26% decrease in risk of developing dementia.

This included a reduction in certain categories of pollution, including traffic-related pollution.

Long-term exposure to air pollution was linked to a possible biological connection to physical brain changes that result in Alzheimer’s disease.

“When you actually modify or change air pollution, decrease it, there actually also seems to be a benefit on cognition in a population that are aging,” Snyder said. “I think these data demonstrate the importance of policies and action by federal, state and local governments to address reducing air pollution.”

Snyder remarked that it’s important for those with loved ones battling the disease to take advantage of community resources to see better outcomes overall.

According to the Alzheimer’s Association, more than 11 million people in the United States provide unpaid care for people with Alzheimer’s or other dementias.

in 2020, these caregivers provided an estimated 15.3 billion hours of care, valued at approximately $257 billion.

Reference: WTOP (July 26, 2021) “Study: New evidence shows link between air pollution, Alzheimer’s disease”

What Does Cleveland Clinic Say about the New Alzheimer’s Drug?

When the drug first debuted, the Cleveland Clinic said it would not administer Aduhelm, the new FDA-approved Alzheimer’s medicine. However, the hospital system was promoting the unproven drug on its social media accounts.

Cleveland Clinic was the first major medical center to say it would not administer Aduhelm, and two hospital systems have followed the clinic’s lead. However, the Cleveland Clinic made a sudden change, as just two weeks ago, the clinic said that the drug offered “hope.”

Axios’ recent article entitled “Cleveland Clinic’s about-face on the new Alzheimer’s drug” reports that the hospital posted the article on Facebook (July) and on Twitter (June 29)— about a month after the FDA approved the drug. Each social media post said the treatment has been “a sign of hope” for the patient.

At the end of the article, a patient says: “There are people who could really benefit from this, so let’s give them the drug. We’d all like to take something that may be able to help us. Hope is hope.”

Babak Tousi, a neuro-geriatrician at the Cleveland Clinic, called the drug “a real turning point in the field of dementia.”

However, a footnote at the bottom of the article discloses that Dr. Tousi is a paid adviser to Biogen.

She has received $16,700 from Biogen and the drug’s co-developer Eisai since 2014, according to federal data.

Dr. Tousi also has received more than $25,000 during that time from Eli Lilly, which makes a competing experimental Alzheimer’s drug.

What they are saying: The Cleveland Clinic did not make anyone available for an interview, and calls to Tousi’s office went unanswered.

A Cleveland Clinic spokesperson said the article was about the trial, and “research is fundamental to our mission. We regularly provide updates on studies we are participating in.”

The Cleveland Clinic spokesperson did not address questions about the article being promoted after the FDA’s approval and that the article said the drug offered “hope,” even though there’s conflicting evidence about whether the drug works.

The spokesperson added, “We support continued research in this area, and when additional data become available, we will re-evaluate this medication for use in our patients.”

Reference: Axios (July 19, 2021) “Cleveland Clinic’s about-face on the new Alzheimer’s drug”

Aging Parents and Blended Families Create Estate Planning Challenges

Law school teaches about estate planning and inheritance, but experience teaches about family dynamics, especially when it comes to blended families with aging parents and step siblings. Not recognizing the realities of stepsibling relationships can put an estate plan at risk, advises the article “Could Your Aging Parents’ Estate Plan Create A Nightmare For Step-Siblings?” from Forbes. The estate plan has to be designed with realistic family dynamics in mind.

Trouble often begins when one parent loses the ability to make decisions. That’s when trusts are reviewed for language addressing what should happen, if one of the trustees becomes incapacitated. This also occurs in powers of attorney, health care directives and wills. If the elderly person has been married more than once and there are step siblings, it’s important to have candid discussions. Putting all of the adult children into the mix because the parents want them to have equal involvement could be a recipe for disaster.

Here’s an example: a father develops dementia at age 86 and can no longer care for himself. His younger wife has become abusive and neglectful, so much so that she has to be removed from the home. The father has two children from a prior marriage and the wife has one from a first marriage. The step siblings have only met a few times, and do not know each other. The father’s trust listed all three children as successors, and the same for the healthcare directive. When the wife is removed from the home, the battle begins.

The same thing can occur with a nuclear family but is more likely to occur with blended families. Here are some steps adult children can take to protect the whole family:

While parents are still competent, ask who they would want to take over, if they became disabled and cannot manage their finances. If it’s multiple children and they don’t get along, address the issue and create the necessary documents with an estate planning attorney.

Plan for the possibility that one or both parents may lose the ability to make decisions about money and health in the future.

If possible, review all the legal documents, so you have a complete understanding of what is going to happen in the case of incapacity or death. What are the directions in the trust, and who are the successor trustees? Who will have to take on these tasks, and how will they be accomplished?

If there are any questions, a family meeting with the estate planning attorney is in order. Most experienced estate planning attorneys have seen just about every situation you can imagine and many that you can’t. They should be able to give your family guidance, even connecting you with a social worker who has experience in blended families, if the problems seem unresolvable.

Reference: Forbes (June 28, 2021) “Could Your Aging Parents’ Estate Plan Create A Nightmare For Step-Siblings?”

What’s the Criticism of the New Alzheimer’s Drug?

Three members of the FDA panel overseeing research have resigned since the approval this week, including Dr. Aaron Kesselheim, a professor of medicine at Harvard Medical School, who said in a letter the agency’s decision on Biogen “was probably the worst drug approval decision in recent U.S. history.”

CNBC’s article entitled “Biogen Alzheimer’s drug and the battle over dementia treatment of the future” reports that last November, in an 8-1 vote, that panel said Biogen’s late-stage study didn’t provide “strong evidence” showing that aducanumab effectively treated Alzheimer’s; two other panelists said that the data was “uncertain.”

While some experts see Aduhelm an “effective treatment” for a disease that affects millions of Americans, others have concerns about the FDA ruling’s implications for the panoply of other potential treatment options that are in late-stage development.

An immediate challenge facing other researchers working on a wider Alzheimer’s drug pipeline will be to keep participants in ongoing trials. In most cases, many Alzheimer’s sufferers will quit other drug studies to pursue treatment with the newly approved Aduhelm. This will make the trial data for those alternative drugs less useful, even though the drugs in question might one day prove safer, more effective, or more appropriate for different stages of the disease’s progression. Nonetheless, Aduhelm’s approval is seen by many as a big boost towards those efforts.

Some major drug companies stopped efforts to research brain diseases, including Pfizer and Boehringer Ingelheim in 2018. Biogen had given up on Aduhelm at one time in the clinical trials in 2019 before reversing its decision. This was after decades of failure in search of a breakthrough.

The National Institutes of Health spent two to three times more on heart disease and cancer research than on dementia in recent years, while a lack of qualified participants for clinical trials also slowed progress.

Aduhelm’s clinical trial data demonstrated that the drug successfully targets and clears out clusters of a specific type of protein that are thought to be responsible for Alzheimer’s. However, it gave insufficient evidence to prove the drug provides patients with cognitive benefits. Known among scientists as aducanumab, it works by offering an array of identical antibodies that are cloned from white blood cells. These antibodies are chosen for their targeting abilities, since they can identify specific proteins, called beta amyloids, that have constructed particular formations in the body. There’s extensive evidence suggesting that these beta amyloid formations, also known as “pathological aggregates” or “plaques,” are a major driver of Alzheimer’s disease, though the exact causal mechanisms are still not fully understood.

“What we’re going to find out from the use of this drug one way or the other, is whether or not the amyloid clearing hypothesis is correct,” says USC health economist Darius Lakdawalla, who argues the continued trialing of Biogen’s drug will prove useful to that confirmatory effort.

“If it is correct, then I think it opens the door for a lot of innovation, a lot of drug candidates that are going to try to clear amyloid in the future pursuit of that hypothesis.”

Reference: CNBC (June 12, 2021) “Biogen Alzheimer’s drug and the battle over dementia treatment of the future”

What Is Elder Law?

With medical advancements, the average age of both males and females has increased incredibly.  The issue of a growing age population is also deemed to be an issue legally. That is why there are elder law attorneys.

Recently Heard’s recent article entitled “What Are the Major Categories That Make Up Elder Law?” explains that the practice of elder law has three major categories:

  • Estate planning and administration, including tax issues
  • Medicaid, disability, and long-term care issues; and
  • Guardianship, conservatorship, and commitment issues.

Estate Planning and Administration. Estate planning is the process of knowing who gets what. With a will in place, you can make certain that the process is completed smoothly. You can be relieved to know that your estate will be distributed as you intended. Work with an experienced estate planning attorney to help with all the legalities, including taxes.

Medicaid, Disability, and Long-Term Care Issues. Elder law evolved as a special area of practice because of the aging population. As people grow older, they have more medically-related issues. Medicaid is a state-funded program that supports those with little or no income. The disability and long-term care issues are plans for those who need around-the-clock care. Elder law attorneys help coordinate all aspects of elder care, such as Medicare eligibility, special trust creation and choosing long-term care options.

Guardianship, Conservatorship, and Commitment Matters. This category is fairly straightforward. When a person ages, a disability or mental impairment may mean that he or she cannot act rationally or make decisions on his or her own. A court may appoint an individual to serve as the guardian over the person or as the conservator the estate, when it determines that it is required. The most common form of disability requiring conservatorship is Alzheimer’s, and a court may appoint an attorney to be the conservator, if there is no appropriate relative available.

Reference: Recently Heard (May 26, 2021) “What Are the Major Categories That Make Up Elder Law?”

Will Mediterranean Diet Stave Off Alzheimer’s?

Researchers at the German Centre for Neurodegenerative Diseases in Bonn found the Mediterranean diet could protect the brain from disease triggers linked to Alzheimer’s, specifically protein deposits and the rapid loss of brain matter.

Barchester’s recent article entitled “Mediterranean diet could lower risk of dementia, study suggests” reports that Alzheimer’s disease is the most common form of dementia, affecting between 50 and 75% of people who are diagnosed with the condition.

Worldwide, approximately 50 million people have dementia. There are roughly 10 million new cases every year.

Alzheimer’s disease is the most common form of dementia and may contribute to 60–70% of cases.

Dementia is one of the primary causes of disability and dependency among older people worldwide.

There are physical, psychological, social, and economic impacts on people with dementia, as well as on their careers, families and society at large.

The recent German study results were published in the journal Neurology. The research involved 512 subjects, with an average age of 70 years. The participants were asked to fill out a questionnaire about the foods they regularly ate. Those who ate a considerable quantities of fish, vegetables and fruit, and only occasionally consumed foods considered less healthy, such as red meat–were given high scores on a scale used by the researchers.

Participants then underwent MRI brain scans and participated in tests examining cognitive functions, such as memory. The study also looked for levels of amyloid beta proteins and tau proteins in the cerebrospinal fluid. These are well-known signs of Alzheimer’s.

The results showed that those with the unhealthiest eating habits had more pathological levels of these biomarkers, when compared with those who regularly ate a Mediterranean diet.

In addition, individuals who regularly ate a significant quantities of fish, fruit and vegetables performed better in memory tests.

The lead author of the study, Tommaso Ballarini, expanding on the findings and explained: “There was also a significant positive correlation between a closer adherence to a Mediterranean-like diet and a higher volume of the hippocampus. The hippocampus is an area of the brain that is considered the control centre of memory. It shrinks early and severely in Alzheimer’s disease.”

The researchers are looking to re-examine the same study participants in four to five years, to have further insights into how nutrition can impact brain aging and health over time.

Reference: Barchester (May 10, 2021) “Mediterranean diet could lower risk of dementia, study suggests”

Link Possible between Diabetes, Dementia and Age

New research says those people who had type 2 diabetes for more than 10 years had more than twice the risk for developing dementia, as compared with those who were diabetes-free at age 70, according to Archana Singh-Manoux, PhD, of the Université de Paris in France.

MedPage Today’s recent article entitled “Diabetes, Dementia, and Age: What’s the Link?” reports that at age 70, every additional five years younger that a person was diagnosed with diabetes was linked to a 24% increased risk of incident dementia, even after adjustment for sociodemographic, health-related and clinical factors including cardiovascular disease, hypertension, body mass index and use of antidepressant or cardiovascular medications, among others.

This is equal to a dementia rate of 8.9 per 1,000 person-years among patients age 70 without diabetes versus a rate of 10 to 18.3 for those with diabetes, depending on age at onset:

  • Diabetes onset 5 years earlier: 10.0 per 1,000 person-years
  • Diabetes onset 6-10 years earlier: 13.0 per 1,000 person-years
  • Diabetes onset 10+ years earlier: 18.3 per 1,000 person-years

The strongest connection with incident dementia appeared to be younger age at onset of type 2 diabetes. Patients at age 55 who were diagnosed with diabetes within the past five years saw a twofold increased risk for incident dementia; those age 60 who were diagnosed with diabetes six to 10 years prior saw a similar twofold increased risk. However, late-onset diabetes wasn’t found to be tied to incident dementia. Prediabetes (fasting blood glucose of 110-125 mg/dL) also was not linked to risk of subsequent dementia. Singh-Manoux said this finding suggested that “a certain threshold of high glucose” might be needed to ultimately see hyperglycemia-induced brain injury.

However, cardiovascular comorbidities played into this link. Patients with diabetes who also had a stroke had a dramatically higher risk for dementia. Those with three heart conditions — stroke, coronary heart disease and heart failure – were at five times increased risk for subsequent dementia. Thus, these findings emphasize the importance of age at diabetes onset and cardiovascular comorbidities, when determining risk for dementia, the study authors said.

A few possible explanations could explain the connection between diabetes and dementia. “One hypothesis is that brain metabolic dysfunction is the primary driver of Alzheimer disease, highlighting the role of decreased transport of insulin through the blood-brain barrier, impairments in insulin signaling and consequently decreased cerebral glucose utilization,” they wrote. This idea was supported by findings from the 2019 SNIFF trial, which found some benefit with 40 IU of daily intranasal insulin for Alzheimer’s disease patients. The group also suggested that episodes of hypoglycemia, more often experienced by those with a longer diabetes duration, may increase the risk for dementia.

Reference: MedPage Today (April 27, 2021) “Diabetes, Dementia, and Age: What’s the Link?”

Does Sleeping Too Little Increase Risk of Dementia?

Researchers have looked at the issue of a lack of sleep and a link to developing dementia for many years, as well as other questions about how sleep relates to cognitive decline. The answers have been tough to find because it is hard to know if insufficient sleep is a symptom of the brain changes that underlie dementia — or if it can actually help cause those changes.

The New York Times’ recent article entitled “Sleeping Too Little in Middle Age May Increase Dementia Risk, Study Finds” reports that a large new study found some of the most persuasive findings to date that suggest that people who don’t get enough sleep in their 50s and 60s may be more apt to develop dementia when they are older.

The research, published recently in the journal Nature Communications, has limitations but also several strengths. Researchers monitored 8,000 people in Britain for about 25 years, starting when they were 50. They found that those who consistently reported sleeping six hours or less on an average weeknight were about 30% more likely than those who regularly got seven hours sleep (defined as “normal” sleep in the study) to be diagnosed with dementia nearly three decades later.

Drawing on medical records and other data from a prominent study of British civil servants called “Whitehall II,” which began in the mid-1980s, the researchers logged the number of hours that 7,959 participants said they slept in reports filed six times between 1985 and 2016. By the end of the study, 521 people had been diagnosed with dementia at an average age of 77.

The team was able to adjust for several behaviors and characteristics that might influence people’s sleep patterns or dementia risk, like smoking, alcohol consumption, how physically active people were, body mass index, fruit and vegetable consumption, education level, marital status and conditions like hypertension, diabetes and cardiovascular disease.

To further clarify the sleep-dementia relationship, researchers culled out those who had mental illnesses before age 65. Depression is considered a risk factor for dementia and mental health disorders are strongly connected to sleep disturbances. The study’s analysis of participants without mental illnesses found a similar association between short-sleepers and increased risk of dementia.

The link also held whether people were taking sleep medication and whether they had a mutation called ApoE4 that makes people more apt to develop Alzheimer’s.

Experts seem to agree that researching the sleep-and-dementia connection is challenging and that previous studies have sometimes produced confusing findings. In some studies, those who sleep too long (usually measured as nine hours or more) seem to have greater dementia risk, but several of those studies were smaller or had older participants. In the new study, results intimated increased risk for long sleepers (defined as eight hours or more because there weren’t enough nine-hour sleepers), but the association was not statistically significant.

The new study also looked at whether people’s sleep changed over time. There appeared to be slightly increased dementia risk in people who shifted from short to normal sleep—a pattern thought to reflect that they slept too little at age 50 and needed more sleep later because of developing dementia.

Reference: New York Times (April 20, 2021) “Sleeping Too Little in Middle Age May Increase Dementia Risk, Study Finds”

Can a Person with Alzheimer’s Sign Legal Documents?

If a loved one has been diagnosed with Alzheimer’s disease or any other form of dementia, it is necessary to address legal and financial issues as soon as possible. The person’s ability to sign documents and take other actions to protect themselves and their assets will be limited as the disease progresses, so there’s no time to wait. This recent article “Financial steps to take when dealing with Alzheimer’s” from Statesville Record & Landmark explains the steps to take.

Watch for Unusual Financial Activity

Someone who has been sensible about money for most of his life may start to behave differently with his finances. This is often an early sign of cognitive decline. If bills are piling up, or unusual purchases are being made, you may need to prepare to take over his finances. It should be noted that unusual financial activity can also be a sign of elder financial abuse.

Designate a Power of Attorney

The best time to designate a person to take care of finances is before she shows signs of dementia. It’s not an easy conversation, but it is very important. Someone needs to be identified who can be trusted to manage day-to-day money matters, who can sign checks, pay bills and supervise finances. If possible, it may be easier if the POA gradually eases into the role, only taking full control when the person with dementia can no longer manage on her own.

An individual needs to be legally competent to complete or update legal documents including wills, trusts, an advanced health care directive and other estate planning documents. Once such individual is not legally competent, the court must be petitioned to name a family member as a guardian, or a guardian will be appointed by the court. It is far easier for the family and the individual to have this handled by an estate planning attorney in advance of incompetency.

An often-overlooked detail in cases of Alzheimer’s is the beneficiary designations on retirement, financial and life insurance policies. Check with an estate planning attorney for help, if there is any question that changes may be challenged by the financial institution or by heirs.

Cost of Care and How It Will Be Paid

At a certain point, people with dementia cannot live on their own. Even those who love them cannot care for them safely. Determining how care will be provided, which nursing facility has the correct resources for a person with cognitive illness and how to pay for this care, must be addressed. An elder law estate planning attorney can help the family navigate through the process, including helping to protect family assets through the use of trusts and other planning strategies.

If the family has a strong history of Alzheimer’s disease or other cognitive diseases, it makes sense to do this sort of preparation far in advance. The sooner it can be addressed, even long before dementia symptoms appear, the better the outcome will be.

Reference: Statesville Record & Landmark (April 11, 2021) “Financial steps to take when dealing with Alzheimer’s”

Does Bacon Cause Dementia?

A recent study suggests there is a connection between eating 25 grams of processed meat per day and a 44% higher risk of dementia. That’s about a single rasher or strip of bacon.

Medical News Today’s recent article entitled “Dementia: 25 grams of processed meat per day may raise relative risk” reports that this research also found a link between eating unprocessed red meats, like beef, pork, and veal, and reduced risks of all-cause dementia.

A gene variant known as the APOE ε4 allele, which increases a person’s risk of dementia by 3–6 times, didn’t appear to affect the relationship between diet and the condition. Those with dementia have difficulties with their memory, attention, thinking and reasoning that interfere with everyday life. These cognitive difficulties aren’t part of the typical aging process.

According to the Centers for Disease Control and Prevention (CDC), in 2014, about five million adults in the U.S. had dementia, but the CDC estimates this number may be close to 14 million by 2060. And the World Health Organization (WHO) reported that there are around 50 million dementia cases globally, with around 10 million new cases being diagnosed annually.

This new study from scientists at the University of Leeds in the U.K. suggests there is a relationship between eating processed meat in particular and an increased risk of developing dementia. This includes sausage, bacon, salami and corned beef.

However, the research also showed that red meat may have a protective effect against dementia.

The scientists analyzed data from the UK Biobank, a database of genetic and health information from around half a million volunteers in the U.K. aged 40–69 years. The participants completed a dietary questionnaire and completed 24-hour dietary assessments. This let the researchers estimate the total amount of meat each participant regularly consumed and how much of each type they ate.

The database also let them identify which participants had the gene variant APOE ε4 allele, which is known to increase a person’s risk of dementia. The researchers then used hospital and mortality records to identify subsequent cases of dementia from all causes, Alzheimer’s disease and vascular dementia during the follow-up period of approximately eight years.

Of the 493,888 participants, 2,896 had all-cause dementia. These included 1,006 cases of Alzheimer’s disease and 490 cases of vascular dementia.

To estimate the role of meat consumption, the researchers had to account for a wide range of other factors that are known to affect a person’s likelihood of having dementia, such as age, gender, ethnicity, education and socioeconomic status. They also considered lifestyle factors, such as smoking, physical activity and consumption of fruits and vegetables, fish, tea, coffee and alcohol. After the adjustments, the scientists at the University of Leeds found that each additional 25g portion of processed meat eaten per day was associated with a 44% increase in the risk of dementia from all causes. This intake was also associated with a 52% increased risk of Alzheimer’s disease.

However, each additional 50g portion of unprocessed meat eaten per day was linked to a 19% reduction in the risk of all-cause dementia and a 30% reduced risk of Alzheimer’s disease. The results for unprocessed poultry and total meat consumption were not statistically significant, the scientists said.

“Worldwide, the prevalence of dementia is increasing, and diet as a modifiable factor could play a role,” says Huifeng Zhang, a Ph.D. student at the School of Food Science and Nutrition at the University of Leeds, who was the lead researcher of the new study.

“Our research adds to the growing body of evidence linking processed meat consumption to increased risk of a range of nontransmissible diseases,” she added.

Reference: Medical News Today (March 29, 2021) “Dementia: 25 grams of processed meat per day may raise relative risk”