ASK THE EXPERT: COMFORT

Question: My mom, who used to pride herself on her cooking, doesn’t want to cook anymore. My dad is complaining about spending so much money eating out, and we’re worried about their health. All this packaged and pre-made food isn’t healthy. Still, I feel like my mom spent her life cooking and shouldn’t have to keep doing it if she’s tired. What other options do you suggest?

Answer: The experience of food can change over our lifetime. Many of us go through periods where we just don’t feel up to cooking. Has your mom indicated why she doesn’t want to cook anymore? Is it just the cooking, or the process of grocery shopping as well? She is certainly entitled to a break, but it might help to identify the root cause of her change in pattern. If she simply is tired of cooking, there are other options. Cooking for two can be very different than the days of cooking for a family; sometimes you just run out of ideas, or it becomes a mundane task. Other times something else is going on, like difficulty remembering the steps, trouble standing or concentrating for long periods of time, or a change in mood or appetite that might signal an underlying cause that should be addressed. Eating out can become costly and requires nighttime driving, which may become an issue at some point and you’re right, pre-packaged food might not be the healthiest option. Here are some options that you might consider:

1. Come up with a list of likes and dislikes for both of your parents. Note any food allergies or tolerance issues. Determine weekly staples for shopping trips. This will help whoever may be helping with meals in the future.

2. Identify when they eat the largest meal of the day, how many meals they eat each day and when they prefer a hot meal. This will help determine a routine and how to best support that with supplemental services.

3. Offer to help her with grocery shopping and meal prep. If you can do this once a week, that would provide for some homecooked options for a portion of the week. They could simply reheat or do the final prep work and it may not seem so overwhelming. Make sure to label and date everything, to avoid any confusion.

4. Consider setting up an online shopping service. There are several options for this, depending on which store they prefer. You can help set this up and assist in weekly shopping, over the phone. You can set up the order on your end, coordinate with them, and arrange for pick up or delivery.

5. Meal delivery services are also an option. Several companies who offer catering, also offer meal plans that can be delivered to the home each week. Some restaurants offer this as well. A quick internet search and a few calls can help you identify options in their area.

6. If your mom has no interest in cooking, and you are not in the area to assist, consider hiring a companion or caregiver to come in a few times a week to assist with grocery shopping and cooking.

7. If you are going to go with pre-prepped foods, look for restaurants or markets that offer healthier options with packaged to go meals. Many health foods stores that have lunch counters, offer premade foods. These would be a step up from just purchasing frozen meals.

8. Look for congregate meal sites or lunch/dinner clubs. The local senior center or area churches may have monthly options that would provide a hot meal and socialization.

It may be a process to establish a new routine and meal options that are appealing to them. The great thing is that we do have many resources they can potentially tap into. Through family, friends, services and possibly hiring a companion to help at home, you can hopefully ease her burden and keep the budget in line for your dad, minimizing the number of times they eat out each week.

In June, ONC loves celebrating the pets in our lives. Our pets are family, offering love, support, humor and a solid reason to get up, get going and get outside! Here are some interesting facts about pet ownership in the US and worldwide – and some research as to why pets are so good for our overall health.

66% of US households own a pet.

69 million Americans have a dog, and 45 million have a cat.

The most popular pet in the US is a dog.

Wyoming is the state with the highest number of pet owners. 72% of people in Wyoming own at least one pet.

The U.K. has the largest reptile pet population in the world.

In France, cats are twice as common as household pets than dogs.

5 million Americans have a snake as their pet.

Fewer than half the households in South Dakota, New Jersey, Massachusetts and Illinois own pets.

Spain, at 13%, has the lowest cat pet population in Europe.

47% of households in Thailand own a dog, compared with 16% in Hong Kong.

From

2010

Cats are the most popular pet in New Zealand, with roughly 41% of households owning at least one.

2020, the pet industry grew 114% in the United States.

–

American pet owners spend the most, globally, on pet food and treats ($42 billion in 2020).

According to research from the University of Alabama, pet ownership is linked to higher levels of cognition and larger brain structure. These effects were greatest in dog owners.

Regularly walking or playing with a pet can actually decrease blood pressure, cortisol levels and triglyceride levels in their human owners.

Research finds that pet ownership is especially beneficial for verbal memory such as memorization of word lists.

For older adults, regular outdoor activities with a pet can improve cognitive function.

Pet ownership also positively affects mental health by decreasing stress, increasing socialization and physical activity and providing unconditional love and support.

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Brain Health Awareness for Aging Well and Thriving in the Second Half

If this sounds like a lot to understand, you’re not alone. The various types of dementia can feel overwhelming. Then, there are the issues of diagnosis, treatment and access to resources. It can feel like wading through mud. Many family members, loved ones and care partners can feel crushed by the sheer amount of information they must learn, decipher and apply to help their loved ones.

With this in mind, OutreachNC is grateful to have access to some of the nation’s top researchers and experts in brain health including Dr. Andrea Bozoki.

by Amy Phariss

Dr. Bozoki is the Division Chief for Memory and Cognitive Disorders at UNC School of Medicine. Dr. Bozoki is also a professor of Memory and Cognitive Disorders and the Outreach and Engagement Core Co-Leader at Duke-UNC’s Alzheimer’s Disease Research Center. Dr. Bozoki helps ONC readers understand the issues related to memory and cognitive disorders, including Alzheimer’s disease. She explains how to help our loved ones, advocate for ourselves and make sustainable changes today for better brain health tomorrow.

ONC: What is the biggest myth about memory and cognitive disorders:

Dr. Andrea Bozoki: The myth that everyone dements if they get old enough. That’s just not true.

What we all get is something called normal cognitive aging. It’s totally a thing and happens to everyone. It’s universal.

You start having cognitive aging in your 30s. Decade by decade, if you test people, they consistently become a little worse and a little worse in certain areas: multitasking, proper noun finding (pulling up names), prospective memory (remembering to remember – going into a room and forgetting why). This is very real. Nothing that we have found will prevent it, but just like wrinkles and grey hair, it happens at different times with different people. Some people notice in their 40s and 50s, and others are untouched or minimally touched by it in their 70s. Plenty of people don’t start getting grey hair until their 60s.

But, nothing about cognitive aging is dementia.

All of what I’ve just described (multi-tasking, proper nouns) are annoyances but are not the same as having dementia. These annoyances don’t impair your day-to-day function, whereas abnormal cognitive aging is the road to developing dementia. When people have abnormal cognitive aging or Mild Cognitive Impairment (a frequent precursor of Alzheimer’s disease) they may forget what they said or repeat. That’s not typical of normal aging.

ONC: How can we minimize cognitive aging or decrease the impact it has on our lives?

AB: Exercise, diet, sleep and paying attention to hearing. These can slow cognitive aging.

ONC: If you could choose one place to start to improve brain health and memory, what would it be? What is the most important change a person can make to make solid improvement?

AB: Daily exercise, at least 30 minutes, of which 10-15 minutes should be “moderately vigorous” – meaning you break a sweat and can keep up a conversation while doing it.

ONC: Can stress and dementia have similar symptoms?

AB: They can but tend to look a little different. The kind of forgetting caused by stress is usually more frontally based in the brain, meaning that the problem is poor sustained attention, poor multitasking, decreased ability to organize information coming in – that looks different on cognitive testing than someone who has a problem with their video camera that records things all day long, the hippocampus. If your hippocampus is broken, you can’t pull in. Your ability to multitask may be just fine, but it never gets from in-the-moment to longterm memory storage.

ONC: What is the role of mental health in brain health?

AB: Huge.

When I see somebody, I’m always asking myself: what are the improvable elements and contributors to this person’s cognitive impairment. It’s rare that someone has just pure Alzheimer’s and nothing else. There are always these lifestyle factors.

If you exercise more, eat a different way (The Mind Diet – it’s the most well-studied at this point, for Alzheimer’s), etc. If someone has depression or anxiety, at a minimum, it’s giving them situation memory block. There is an entity called pseudodementia. It looks like Alzheimer’s disease but might be depression alone.

ONC: What would you say to a spouse or loved one who is feeling frustrated in caring for someone living with dementia?

AB: One piece of advice for caregivers: choose your battles. Not everything is worth pushing back on. There are lots of battles caregivers sometimes have with demented family members. I say: this is not the hill to die on. Daily bathing is a big thing. Just let it go. Use a washcloth if you absolutely feel the need but stop fighting that fight so hard.

The battles worth having are the ones that lead to significant quality of life or lead to slowing the progression of the disease.

Hearing loss is an example of a battle worth having for people who are not yet demented. Untreated hearing loss is a significant driver for developing dementia.

The Biden administration has finally, after huge pushback from insurance companies and makers of hearing aids, authorized over-the-counter hearing aids. You no longer need to have a prescription, and prices are finally starting to drop. The financial barrier for hearing aids has been enormous.

I normally recommend patients wear hearing aids all day, every day unless you’re in a very loud environment (then wear earplugs) but wear hearing aids the rest of the time. So, this is an example of when a loved one shouldn’t find ways to accommodate someone. Find a way to get the loved one the hearing aids they need.

Sleep regulation is another battle worth having. Sleep is so important to the brain. If someone is only sleeping 5 or 6 hours a night, that’s a treatable risk factor. Getting them up to 7 hours a night is possible and very important. Getting a CPAP device is equally important for someone who has sleep apnea, which can affect quality of sleep.

ONC: Many forms of dementia don’t yet have great treatment options. Can you describe any recent research studies addressing new treatment options?

AB: Because of the last decade of research studies and the thousands of individuals living with Alzheimer’s disease who were gracious enough to volunteer their time, we are about to have diseasemodifying treatments available for early/mild

Alzheimer’s disease for the first time. These drugs will not be without risks, and are definitely not a cure, but there will finally be something I can offer to patients that can slow down their disease progression. That’s a huge step forward.

ONC: Do you recommend patients participate in these studies? What would you say to a patient interested in exploring clinical research related to their diagnosis?

AB: Yes, I do. Clinical trials look at new drugs or vaccines that may help treat or prevent disease, look at ways of detecting or finding out more about a disease, and monitor new drugs or evaluate new combinations of established treatments. The main goal of clinical trials is to see if these new drugs or technologies are safe and work to cure or treat the illness being studied.

Many people dealing with Alzheimer’s disease want to do something to help find a better treatment or a cure. They want to help others. One way to help is to participate in research. Not only does research help future generations, but it may help those participating in the study as well. Study participants may receive new medications or free check-ups as a part of their participation.

At the NC Registry for Brain Health, we believe that diverse perspectives are critical to achieving health equity — meaning that all communities have a fair and just opportunity for early diagnosis and access to risk reduction and quality care. When you join the Registry, you will also receive regular updates including quarterly newsletters filled with brain health information, research discoveries, events, and resources to help you and your loved ones. Any North Carolinian over the age of 18, with or without a memory disorder, is welcome to join the Registry. To learn more and join, please visit: ncbrainhealth. org; you can also contact the registry staff at 919.613.8633 or NCBrainHealth@duke.edu

We are grateful to Dr. Bozoki for her insight, perspective and education on the topic of brain health. We are also grateful to Latorius Adams, who always keeps ONC readers connected to top experts and information in fields that matter to aging well. Outreach begins with information and connection, and Ms. Adams and Dr. Bozoki’s contributions are greatly appreciated.

Dr. Bozoki mentions the MIND Diet as a great option for improving brain health. We obviously wondered: what is the MIND Diet? Is the MIND diet accessible for the average American or a complicated, expensive eating plan? Here’s what we found.

The MIND Diet stands for: MediterraneanDASH Diet Intervention for Neurogenerative Delay.

Whew. It’s a mouthful (we know).

According to the Harvard T.H. Chan School of Public Health, the MIND Diet “targets the health of the aging brain.” The MIND Diet is based on research from the Rush Memory and Aging Project (MAP), which followed a group of older adults for up to 10 years. These adults did not have dementia when signing up for the study. Researchers analyzed their meals to determine which foods and serving sizes were associated with protection from dementia and cognitive delay.