balance a publication of HCR ManorCare
Brain Health
balance
BRAINHEALTH
Mind over
Matter
Men and women are not prisoners of fate, but only prisoners of their own minds.” F R A N K L I N D. RO O S E V E LT
balance
F
ranklin D. Roosevelt’s intent when speaking these words was purely philosophical and meant to remind us that our potential was only limited by our capacity to dream. For any of the 200 million individuals living with a disease that effects the mind, however, that idea of the mind as a prison is a stark reality. The brain, as the control center of the body, is responsible for receiving input from our sensory organs and sending output to the muscles of our body. Indeed, the human brain as the most complex organ in the human body produces our every thought, action, memory, feeling and experience of the world. This jelly-like mass of fat and protein, weighing in at around 3 pounds, contains a staggering one hundred billion nerve cells, or neurons, that can process information at speeds as fast as 268 miles/hour. The sheer complexity of the connectivity between these cells is mind-boggling. Each neuron of the brain can make contact with thousands or even tens of thousands of other neurons via tiny structures called synapses. In fact, our brains form a million new connections for every second of our lives. It is in these changing connections that memories are stored, habits are learned and personalities are shaped simply by reinforcing certain patterns of brain activity and losing others. Experts estimate that in a lifetime, a human brain may retain up to one quadrillion separate bits of information.
Beth Pummill, centerbased Geriatric Nurse Practitioner, works daily with physicians such as Svetlana Mishulin, MD, Board Certified Internal Medicine, to provide medical care to patients in Heartland and ManorCare centers. This collaboration between physicians and Heartland Care Partner nurse practitioners is part of the practice model in our higher acuity skilled nursing and rehabilitation centers.
Making sense of the brain’s mind-boggling complexity isn’t easy. Scientists claim that the most complicated and mysterious thing in the universe is the human brain. We know more about stars exploding billions of light years away than we know about the brain. What we do know about the brain is that it is the organ that makes us human. It gives us the capacity for art, language, moral judgments, and rational thought. It is also responsible for each of our individual personalities, memories, movements, and for how we sense the world. The brain is an evolving organ that is constantly changing. During childhood, the brain gets “wired up.” It forms the foundation of the functionality and patterns that take us into adolescence. During adolescence, the frontal lobe undergoes a surge of development which establishes who we will become as an adult. As an adult, the most important trait of the brain is its ability to adapt to new experiences. And as we age well into our 70s and beyond the brain should allow us to continue to be creative and productive members of humanity. In fact, while studies of the brains of older people show some decrease in the number of neurons below the cerebral cortex, they contradict the once popular belief that adults lose an enormous number of neurons every day. The changes to cell processes that we see may represent yet another finetuning of our cerebral networks. Unfortunately the all too common conditions such as stroke, traumatic brain injury, Alzheimer’s dementia, and cancer which impact over 400 million people nationally disrupt brain function and often cause significant and detrimental cognitive and physical impairments.
1
balance
BRAINHEALTH
C Stroke
2
• Gets lost.
Eligibility standards include:
• Has trouble handling money and paying bills.
• a dedicated stroke-focused program
• Repeats questions.
• staffing by qualified medical professionals trained in stroke care
• Takes longer to complete daily tasks.
• individualized care to meet stroke patients’ needs
• Loses things or misplacing them in odd places.
• Displays poor judgment.
• Displays mood and personality changes.
• patient involvement in their hospital care • coordination of post-discharge patient self-care based on recommendations of the Brain Attack Coalition and guidelines published by the American Heart Association/American Stroke Association or equivalent guidelines • streamlined flow of patient information while protecting patient rights, security and privacy • collection of the hospital’s stroke- treatment performance data • hospital team performance data
minutes
For patients that have suffered a stroke, time is of the essence. With timely treatment, however, the risk of death and disability from stroke can be lowered. Whether receiving treatment within the first three hours which may help prevent the progression of the damage to the brain or beginning rehabilitation once medically stable to facilitate the recovery, early and aggressive intervention have been
Strokes
A stroke occurs when the blood supply to the brain is cut off or when a blood vessel bursts. Most strokes are of the ischemic type due to the decrease in blood supply to the brain. Without oxygen which is transported by the red blood cells, brain cells begin to die. When brain cells die, death or permanent disability can result. High blood pressure, smoking, and having had a previous stroke or heart attack increase a person’s chances of having a stroke. Anyone, including children can have a stroke. Therefore it is very important to know the symptoms of a stroke and to ask your doctor about how you can adjust your lifestyle. Several factors that are beyond your control can increase your risk for stroke including your age, sex, and ethnicity. However, there are many unhealthy habits that you can change including smoking, drinking too much alcohol, and not getting enough exercise. Having high cholesterol, high blood pressure, or diabetes also can also increase your risk for stroke.
account for one death every
erebral Vascular Accidents (CVAs) or strokes are a major cause of brain impairment and remain one of the leading causes of death in the United States. Each year, about 800,000 people in the United States have a stroke. Strokes account for one death every 4 minutes in the United States alone. Of those individuals who survive a stroke, four million of them are living with impairments and 15 to 30 percent are permanently disabled.
According to the National Institute on Aging, someone with Alzheimer’s disease may also experience one or more of the following signs:
well demonstrated in the literature to improve outcomes. The American Heart Association has established Primary Stroke Center Certification which recognizes hospitals that meet standards to support better outcomes for stroke care.
• use of data to assess and continually improve quality of care for stroke patients These strategies which have been implemented in many acute care settings nationwide have been expanded into the post hospital environment allowing for a successful transition from hospital to post hospital rehabilitation to home. HCR ManorCare’s team of physicians, consulting neurologists, center-based nurse practitioners, nurses, therapists and dietitians strive to ensure proper compliance with established medical regimens, specific evidenced-base care pathways, therapeutic interventions and patient education in an effort to improve the quality of lives of our patients while reducing unnecessary and preventable hospital readmissions, morbidity and mortality.
Specialty physicians, like medical director Mark Smith, MD, Board Certified Internal Medicine, bring a unique combination of medical expertise and compassion to the day-to-day practice of medicine in Arden Courts memory care communities. This focus on individual care helps residents like Anne maintain a healthy quality of life.
Aging & Dementia hile aging does not typically lead to a pronounced decline and loss of cognitive ability, studies have identified that neurons in regions below the surface of the brain do begin to decrease in number even as early as age 20. These changes in cell processes cause the ability for us to recognize faces or find our car in a parking lot to wane. In our 30s, as these changes occur we may discover that we have more difficulty remembering peoples’ names. Despite these subtle changes, it is still highly likely that our general vocabulary and knowledge about the world will stay sharp even through our 70s. In fact, contrary, to popular belief we do not lose an enormous number of neurons as we age. Some scientists, probably the ones who are more advanced in age, argue that these neuronal changes may represent yet another fine-tuning of our cerebral networks, as we gain more patience, forbearance, and wisdom with age.
Alzheimer’s disease is not a normal part of aging. It is a progressive disease which involves the parts of the brain that control thought, memory and language. It often begins after the age of 60 with mild memory loss and can lead to the loss of one’s ability to carry on a conversation and to respond to one’s environment. It can seriously affect a person’s ability to carry out their daily activities. Although scientists are learning more every day, right now, they still do not know what causes Alzheimer’s disease. There probably is not one single cause, but several factors that affect each person differently. Age is the best known risk factor for Alzheimer’s disease. Researchers believe that genetics may play a role in developing Alzheimer’s disease. They are also studying whether education, diet, and environment play a role in developing the disease. Scientists have found evidence that some of the risk factors for heart disease and stroke, such as high blood pressure, high cholesterol, and low levels of the vitamin folate may also increase the risk of Alzheimer’s disease. Evidence is also growing for physical, mental, and social activities as protective factors against Alzheimer’s disease.
If you or someone you know has several or even most of the signs listed above, it does not mean that you or they have Alzheimer’s disease. It is important to consult a health care provider when you or someone you know has concerns about memory loss, thinking skills, or behavioral changes. Although there is no known cure for Alzheimer’s disease, active medical management can improve the quality of life for individuals living with Alzheimer’s disease and their caregivers. Treatment focuses on several different aspects including helping people maintain mental function, managing behavioral symptoms, and slowing or delaying the symptoms of the disease. Studies have shown that individuals who are progressing in Alzheimer’s and related dementias benefit from structured ongoing activities, individualized lifestyle programming, nutritious meals and socialization. Memory Care programs like those offered at Arden Courts provide a unique approach to caregiving that has been created to help people with Alzheimer’s disease and related memory impairments while receiving the professional assistance they need.
When managing conditions such as stroke, traumatic brain injury, Alzheimer’s, dementia, and cancer, post hospitalizations programs like those offered at HCR ManorCare for long term acute care, skilled care, dementia care, assisted living, home care and hospice will be a critical step in improving patient care.
3
BRAINHEALTH
Understanding
Stroke Risk
H
High Blood Pressure (HBP) BP is the No. 1 cause of stroke and the most important controllable risk factor for stroke. People who are overweight or obese, over age 35, have a family history of HBP, AfricanAmericans, pregnant women, and those who are physically inactive, eat too much salt and/or drink too much alcohol are at higher risk for HBP. Of all people with high blood pressure, more than 20 percent are unaware of their condition. Are you one of them? If you don’t know, see a healthcare professional to be tested.
How can you control your blood pressure? • Eat a better diet, which may include reducing salt intake. • Engage in regular physical activity. • Maintain a healthy weight. • Manage stress. • Avoid tobacco smoke. • Take your medication as prescribed. • If you drink alcohol, limit your intake (no more than one drink per day for women and two drinks per day for men).
4
Talk to your doctor about stroke risk.
Cigarette Smoking
Physical Inactivity and Obesity
The nicotine and carbon monoxide in cigarette smoke damage the cardiovascular system in many ways. The use of oral contraceptives combined with cigarette smoking greatly increases stroke risk.
Being inactive, obese or both can increase your risk of high blood pressure, high blood cholesterol, diabetes, heart disease and stroke. So go on a brisk walk, take the stairs and do whatever you can to make your life more active. Try to get a total of at least 30 minutes of activity on most or all days.
Diabetes Mellitus Many people with diabetes also have high blood pressure, high blood cholesterol and are overweight. This increases their risk even more. Though diabetes is treatable, the presence of the disease still increases your risk of stroke.
High Cholesterol It also appears that low HDL (“good”) cholesterol is a risk factor for stroke in men, but more data are needed to verify its effect in women.
Poor Diet
Atrial Fibrillation
Diets high in saturated fat, trans fat and cholesterol can raise blood cholesterol levels. Diets high in sodium (salt) can contribute to increased blood pressure. Diets with excess calories can contribute to obesity. But a diet that includes five or more servings of fruits and vegetables per day may reduce stroke risk.
The heart’s upper chambers quiver instead of beating effectively, which can let the blood pool and clot. If a clot breaks off, enters the bloodstream and lodges in an artery leading to the brain, a stroke results.
Other Heart Disease People with coronary heart disease or heart failure have a higher risk of stroke than those with hearts that work normally. Dilated cardiomyopathy (an enlarged heart), heart valve disease and some types of congenital heart defects also raise the risk of stroke.
Sickle Cell Disease (Sickle Cell Anemia)
Every 40 seconds someone suffers a stroke.
The genetic disorder mainly affects AfricanAmerican and Hispanic children. “Sickled” red blood cells are less able to carry oxygen to tissues and organs. These cells also tend to stick to blood vessel walls, which can block arteries to the brain and cause a stroke.
Peripheral Artery Disease Peripheral Artery Disease is the narrowing of blood vessels carrying blood to leg and arm muscles. It’s caused by fatty buildups of plaque in artery walls. People with peripheral artery disease have a higher risk of carotid artery disease, which raises their risk of stroke.
Carotid and Other Artery Disease The carotid arteries in your neck supply blood to your brain. A carotid artery narrowed by fatty deposits from atherosclerosis may become blocked by a blood clot. Carotid artery disease is also called carotid artery stenosis. Material from American Heart Association American Stroke Association
5
balance
balance
BRAINHEALTH
According to the National Stroke Association, stroke is the fourth leading cause of death in the United States, and the leading cause of adult disability. A stroke occurs when the blood supply to part of the brain is reduced or completely cut off, depriving the brain tissue of oxygen and food and causing brain cells to die.
What will you score?
Risks and Symptoms of Stroke Previous Stroke or Transient Ischemic Attack TIA (mini stroke)
Up to 80% of strokes are preventable by making lifestyle changes to reduce risk factors. The faster a person suffering a stroke receives medical attention, the better their chance of recovery. Acting F. A.S.T. (Face. Ask the person to smile. Does one side of the face droop? Arm. Ask the person to raise both arms. Does one arm drift downward? Speech. Ask the person to repeat a simple phrase. Is their speech slurred or strange? Time. If you observe any of these signs, call 9-1-1 immediately) at the first signs and symptoms of a stroke is important in ensuring prompt treatment is received. According to the National Stroke Association, for each minute that passes after blood flow to the brain is restricted, a person loses 1.9 million neurons which can effect speech, movement, memory and other functions.
High blood pressure RISKS
High cholesterol Heart disease
Numbness or weakness of the face, arm and/or leg, especially on one side of a person’s body
If you believe you or someone else is experiencing a stroke, call 9-1-1 immediately and note the time of the first symptom as this can effect treatment.
Confusion or trouble speaking or understanding
TIPS TO IMPROVE AGING BRAIN FUNCTION
• Use it or lose it! • Keep your brain’s “library of experience” in regular, vigorous use. Volunteer to work in the community or join the Peace Corps. • Engage in new activities. Take up painting, become a tutor, go back to school! The possibilities are endless. • Do crossword puzzles, play word games or cards to strengthen the synapses between brain cells in memory transmission areas. • Physical exercise can increase mental abilities 20% to 30%, according to recent studies.
SYMPTOMS
Trouble seeing in one or both eyes
Trouble walking, dizziness, loss or coordination of balance
Severe headache with no known cause
• Spend time in the company of family and friends. The older brain thrives on social contact.
Did you score higher in the ”higher risk” column or are unsure of your risk? Talk to your healthcare provider about how you can reduce your risk. * Some stroke risk factors cannot be changed such as age, family history, race, gender, and prior stroke.
• Journal writing and working with your hands to build or create can help as well.
6
Higher Risk
The National Stroke Association - http://www.stroke.org/
7
balance
HEALTHTIP
Many individuals throughout various stages of life recognize the importance of regular physical exercise to maintain health and physical function. Wellness services, fitness centers, parks and senior centers offer physical activities and fitness experiences on a routine basis. Cognitive fitness or exercising one’s thinking abilities is another important aspect of healthy routines that one should consider. Cognitive decline may be described as one of the biggest fears of our aging population. In fact many individuals would identify that they fear cognitive decline over physical decline. Decades of research relate to the favorable impact of cognitive stimulation on reducing the risk of dementia. Prevention of cognitive decline can occur through modifying lifestyle habits as well as a concerted, focused plan of cognitive stimulation. Modifiable lifestyle habits to support cognitive health include:
Muscle Developing a cognitive fitness plan. Selecting foods that are known for their brain boosting benefits is an easily modifiable approach toward maintaining cognitive health. Foods rich in Omega 3 (cold water fish like salmon, tuna, halibut and trout) as well as walnut, ground flaxseed, winter squash and spinach can easily be incorporated into a brain boosting diet plan. Other brain boosting foods are fruits like berries, bananas, apricots, mangos and melons. Good sleeping and eating habits are two ways to support a brain healthy lifestyle.
6. Participating in leisure activities.
Healthy lifestyle choices like regular exercise and social relationships also foster good brain health. Physical exercise is known for maintaining or restoring one’s physical status. Additional benefit is that aerobic exercise increases healthy cognitive function. Aerobic exercise supports the health of the brain by improving oxygen levels and nutrient delivery. Examples of continuous aerobic exercise include running, cycling and swimming.
Creating a regular sleep habit is important for brain health and one’s overall cognitive well-being. During one’s sleep the brain shrinks in size allowing cerebrospinal fluid to “wash” the brain of plaques and tangles that are associated with the development of Alzheimer’s dementia.
Active social relationships provide leisure opportunities that inherently create thinking challenges – card clubs, game nights, book clubs and bible study sessions. Also, social relationships can foster a support network, reduce stress and facilitate opportunities for engagement in altruistic activities and enjoyment!
1. Establishing regular sleep habits, 2. Eating a brain boosting diet, 3. Engaging in physical exercise, 4. Maintaining active social relationships, 5. Managing stress and
8
Flex your memory
Brushing your teeth with your non-dominant hand is a form of neurobic exercise which helps to stimulate your brain
Exercise supports the health of the brain by improving oxygen levels and nutrient delivery
n additional type of exercise is known as “neurobic” exercise. It is based on the premise that brain stimulation can occur when engaged in activities that stimulate more than one sense at a time or are unique because the “routine” activity is performed a little differently. Routines, habits and familiar ways of doing our day to day activities are comforting and require less mental energy. When one intentionally performs activities in a modified way or in a different environment, stimulation of the brain occurs. Examples of neurobic activities or exercise include: brushing your teeth with your non-dominant hand, shopping at a different grocery store, listening to music while adding an aromatic scent of a candle or essential oil or lotion. Neurobic exercise can be a fun way to stimulate your brain – even thinking about neurobic opportunities can facilitate creative thinking. There are also commercial websites and resources for individuals to engage in cognitive challenging exercise. Many computer based games or applications can be easily accessed to intentionally challenge one’s thinking skills. A few commercial resources include Luminosity, Dakim and www.improvememory.org.
Social relationships also foster a support network and reduce stress
Keep in mind that if cognitive decline is impacting your ability to engage in day to day activities, be active in purposeful roles or communicate a discussion with your health care professional which may lead to a referral to a rehabilitation professional (occupational or speech therapy) that is trained in cognitive assessment and treatment. Maintaining or improving one’s cognitive health is easy and important for individuals to do across the lifespan. It is never too late to intentionally engage in a cognitive fitness plan. http://www.acl.gov/Get_Help/BrainHealth/docs/ BrainHealthFactSheet.pdf
9
balance
NUTRITION
Is your diet
brain-healthy? Choose cold water fish which contain omega-3 fatty acids.
There are several things you can do to promote brain health.
Vegetables with dark skins are high in antioxidants.
Manage your weight. A long-term study of 1500 adults who were obese in middle age found that individuals were twice as likely to develop dementia in later life. Participants in the study were six times more likely to develop dementia if they also had elevated cholesterol and blood pressure. Decrease intake of foods high in saturated fats and cholesterol.
These include salmon, halibut, trout or tuna.
10
A
diet that is healthy for your brain is one that reduces the risk of heart disease and diabetes, boosts good blood flow to the brain and is low in cholesterol and saturated fats. Your brain requires the right balance of nutrients including protein, carbohydrate and antioxidants to function well. In addition to a healthy diet, physical and mental activities as well as social interaction can help to keep your brain performing at its best.
These foods can block arteries which has been associated with Alzheimer’s disease. Choose monounsaturated and polyunsaturated fats such as olive oil and bake or grill foods rather than frying.
Obesity contributes in developing dementia.
Choose monounsaturated and polyunsaturated fats such as olive oil.
Increase intake of protective foods. Vegetables and fruits with dark skins are high in antioxidants, which are beneficial substances that have shown to reduce the effects of aging. Vegetables include kale, spinach, Brussels sprouts, beets, red peppers, eggplant and onions. Fruits include blueberries, strawberries, raspberries, plums, oranges, red grapes and cherries. Cold water fish containing omega-3 fatty acids are also beneficial including halibut, salmon, trout and tuna. Nuts including walnuts, almonds and pecans are also rich in antioxidants. While there are no exact amounts of these foods to include in your diet, a combination of weight maintenance and the intake of healthy fats and antioxidants can help promote brain health.
Phyllis J. Famularo, DCN, RD, CSG, LDN Sodexo- Regional Nutrition Manager
11
THEPHARMACY
Aspirin & Stroke - A preventative combination
From willow bark to aspirin
A
nti-inflammatories are taken daily for the treatment and prevention of stroke, headaches, muscle pain, arthritis, fevers and other minor aches and pains. We take them with a glass of water and expect them to do their job by relieving our discomfort. But, we take for granted the ingredients used in the anti-inflammatories and the qualities they possess to alleviate our symptoms. Willow Bark, from the White Willow or Weeping Willow Tree, is a natural anti-inflammatory used in aspirin. Willow bark contains an active ingredient called Salicin, which researchers believe can be used to reduce pain and inflammation. In fact, the use of willow bark as a pain relieving substance can be traced back to the time of Hypocrites, when people would bite down and chew on willow bark for the purpose of relieving their pain. Years of research and trials have proven that the people of Hypocrites time were correct in discovering the benefits of willow bark in treating certain ailments. Chemists have since modified Salicin and created aspirin, or acetylsalicylic acid. Aspirin works by reducing the levels of prostaglandins, chemicals that are released when there is inflammation, by blocking the enzyme that makes prostaglandins (cyclooxygenase) reducing inflammation, pain and fever. Inhibition of prostaglandins has also been found to reduce the function of platelets and the ability of blood to clot, thus thinning the blood.
The Willow Bark is a natural anti-inflammatory used in aspirin. and contains an active ingredient called Salicin, which researchers believe can be used to reduce pain and inflammation
Aspirin and Stroke Prevention Because of the blood thinning characteristics of aspirin, a doctor may prescribe daily aspirin therapy for patients who are at risk of suffering a stroke. Daily aspirin therapy should only be started under the guidance of a physician after carefully weighing the risks and benefits to each individual. A daily aspirin can aggravate certain conditions such as bleeding stomach ulcers, blood clotting disorders and allergies to the components of aspirin. Side effects to daily aspirin therapy include:
• Upset stomach • Heart burn • Gastrointestinal bleeding • Vertigo, or dizziness • Rash • Liver toxicity • Tinnitus (ringing in the ears) When stopping an aspirin regiment, be sure to consult your physician. Suddenly stopping aspirin therapy can trigger a blood clot that could potentially cause a stroke or heart attack. You also need to let your physician know of any other prescriptions or over-the-counter medications that you take as aspirin can interfere with certain medications, causing side-effects or changing their effectiveness. Such medications include certain antibiotics and blood thinners such as Warfarin (Coumadin).
Sources: Willow bark | University of Maryland Medical Center http://umm.edu/health/medical/altmed/ herb/willow-bark#ixzz3IFjNCIYY http://www.mayoclinic.org/diseases-conditions/heart-disease/in-depth/daily-aspirintherapy/art-20046797 Web MD - http://www.webmd.com/vitamins-supplements/ingredientmono-955willow%20bark.aspx?activeingredientid=955&activeingredientname=willow%20bark
12
http://www.medicinenet.com/acetylsalicylic_acid/article.htmWHen
balance a publication of HCR ManorCare
www.hcr-manorcare.com HCRMC-0029A ŠCopyright 2015