TIME Aging

These Common Mood Changes Can Signal Early Alzheimer’s

The vast majority of people with Alzheimer’s disease will experience changes like depression and anxiety. But a new study published in the journal Neurology shows that behavioral changes like these start well before they begin to have memory loss.

The researchers looked at 2,416 people over age 50 without cognitive issues. After following them for seven years, researchers found that 1,218 people developed dementia.

Those with dementia had twice the risk of developing depression earlier—far before their dementia symptoms started—than people without the disease. They were also more than 12 times more likely to develop delusions. The symptoms appeared in consistent phases: first, irritability, depression, and nighttime behavior changes; followed by anxiety, appetite changes, agitation and apathy. The final phase was elation, motor disturbances, hallucinations, delusions and disinhibition.

Though the researchers were able to make the connection, they still cannot confirm for certain whether the changes in the brain that cause one shift in behavior are the same changes that cause memory loss. But understanding when symptoms related to Alzheimer’s disease appear could one day lead to earlier interventions.

Read next: The Science Behind Why Dogs Might Just Be Man’s Best Friend

MONEY Aging

When Dementia Threatens a Family’s Finances

Grandfather at table of food
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One in three adults will suffer from dementia. Here's how to achieve financial security — and a patient's dignity — when that happens.

My client sat across the table telling me about her late husband — first, his diagnosis of dementia, and then, his suicide a few years later.

On the night before he took his own life, she had finally gathered the strength to tell him he needed to turn their finances over to her. Larger than life when he was healthy, he had been a tremendous businessman. But the dementia had robbed him of sound decision-making, and she needed to protect what was left of their shrinking nest egg.

She asked me, “What should I have done?”

In the years since his death, she couldn’t help wondering whether that final financial conversation had been the tipping point in his waning will to live. It wasn’t her fault; she had supported him throughout his illness with an unmatched strength of conviction and marital devotion. It’s pointless to try to judge the effect of a particular conversation, because he had suffered for a decade. The disease had torn through their lives, leaving a series of wreckages: their relationships, his ability to handle even menial tasks, and — perhaps most painful — his self-esteem.

I told my client she had been in a no-win situation. She couldn’t risk her own future welfare by allowing her husband’s disease to squander all they had worked for. She was in her 60s, very healthy, and had a 100-year-old mother whose zest and longevity foretold of my client’s likely need to support herself for another 30-plus years. To protect herself and her husband from risky investments, unwise purchases and even fraud, my client needed to take over the financial reins. But how do you conduct this crucial conversation about control without robbing a dementia patient of his or her already-declining dignity? With the Alzheimer’s Association reporting one in three seniors in the United States contracts Alzheimer’s or dementia, it’s time we start talking about it.

Some advice:

Avoid a crisis. Don’t wait to have one huge conversation. Ideally, you would have a series of talks before anyone is diagnosed with dementia. As part of an overall estate plan, it’s important to discuss all family members’ wishes for the end of their lives and prepare them for the possibility of losing their independence. It may sound trite to say, “One day, Dad, we may take care of you the way you took care of us,” but laying that foundation ahead of time may soften the blow. It’s nice to think that we live on our own until the end, when we quietly pass in our sleep, but that isn’t our current reality. Medical advances have been successful in prolonging our lives, but not at guaranteeing our independence.

Having a big discussion that feels like a dementia patient is the subject of an intervention is stressful for all involved. Save the intervention-type conversations for true emergencies, and recognize the patient needs to feel safe and loved, not confronted.

Understand the backstory. Everyone brings a different money mindset to this conversation. Ask yourself, why is money important to this patient? Is it imperative to provide for the family? Is it a priority to give it away? Open the conversation by affirming the ways the patient has accomplished his financial objectives until this point.

Take into account any major financial experiences that may be coloring this particular conversation. Olivia Mellan, a psychotherapist specializing in money conflict resolution, points out that men and women can have different views of common financial decisions. If a wife wants to open her own bank account, for example, she may simply desire some independence. Her husband, however, may interpret her wishes as a lack of marital commitment. If a dementia patient has had this kind of conflict, structure your discussion to avoid triggering those old memories and feelings.

Pick your battles. Can the patient retain investment control over a $10,000 account? Is there room in the budget for a weekly allowance so he can continue making spending decisions? Both tactics can distract the patient from participating in larger financial decisions.

Steven A. Starnes, an adviser with Savant Capital Management, tells a story about his late grandmother, who passed away from Alzheimer’s. Out shopping with her daughter, she found a relatively expensive necklace she just had to have. The family had created room in the budget for one-time splurges that would bring joy to her remaining years. As long as the purchase didn’t thwart the family’s long-term financial plans, it was okay. So Starnes’ grandmother came home with a new necklace that drew her focus away from the other losses she was experiencing.

Utilize helpful resources. Some financial advisers are a tremendous help in facilitating these conversations. A person’s declining financial abilities are often the first sign of dementia, so advisers are well-positioned to help a family. Just having an outside party to ask the tough questions can ease the pressure. In fact, some advisers, including Starnes, specialize in clients with dementia.

A growing number of professionals specialize in different end-of-life issues. The National Association of Professional Geriatric Care Managers provides information about care management and a directory of professionals who can help clients attain their maximum functional potential

Another source to locate a professional is the Society of Certified Senior Advisors listing of certificants who have demonstrated expertise in a range of core competencies involving the aging process. Among those holding CSA accreditation are financial professionals, caregivers, gerontologists, and clergy.

To help a family prepare for a discussion of changing financial responsibilities, circulate the book Crucial Conversations, by Kerry Patterson. Another great resource is The Other Talk,by Tim Prosch, which specifically addresses end-of-life conversations between aging parents and adult children. Do some research on the best ways to communicate with dementia patients. It’s difficult work, but it is possible to absolve a dementia patient of financial responsibilities while helping him maintain his dignity.

———-

Candice McGarvey, CFP, is the Chief Story Changer of Her Dollars Financial Coaching. By working with women to increase their financial wellness, she brings clients through financial transitions. Via conversations that feel more like a coffee date than a meeting, her process improves a client’s financial strength and peace.

TIME Aging

Taking Care: An Intimate Look at How Parkinson’s Disease Has Changed 1 Family’s Life

“Taking Care” is a series intimately covering the lives of caregivers and the people they care for. This month’s edition is on Parkinson’s Disease

When Eleanor Copeman was diagnosed with Parkinson’s disease, an incurable condition that gradually attacks the nervous system and impairs even simple movements, family life for the Copemans changed forever. The vibrant, joyful matriarch who loved cooking for her family became dependent on her husband Douglas and daughter Tammy for everything from preparing meals to getting dressed.

Now, almost a decade later, Eleanor also has dementia, which strikes 50-80% of people with Parkinson’s. The physical and emotional burdens of caretaking fall to the family.

Eleanor Copeman sweeps the porch outside the family home as her daughter rides her horse toward the house in Elkins, West Virginia, on July 14, 2012. Abby Kraftowitz

“Physically, taking care of someone with Parkinson’s is intense—you have to be on 24/7,” Tammy Copeman tells photographer Abby Kraftowitz, who has been documenting the Copemans’ lives since 2012. “I think it’s just a whole different level of love and loving your family.”

Douglas says he chose to take care of Eleanor at home to honor a promise he made to her 51 years ago when they first married.

Kraftowitz’s work offers a deep look into life inside one household touched by this chronic disease.

Abby Kraftowitz is a photographer based in New York City. You can follow her on Twitter @abbykraftowitz.

TIME Aging

How Moodiness and Jealousy May Lead to Alzheimer’s

Researchers say certain personality traits, like jealousy, worry, anxiety and anger, can double a woman’s chances of developing Alzheimer’s

We’re familiar with many of the brain-related factors that can contribute to Alzheimer’s disease—letting thinking networks go inactive, putting off exercise and healthy eating, having few social connections, enduring head injuries and genetic factors. But what about personality? Can the way you look at the world affect your risk of developing the neurodegenerative disorder?

Dr. Ingmar Skoog, professor of psychiatry and director of the research center on health and aging at the University of Gothenburg believes the answer is yes. In a paper published in the journal Neurology, he and his colleagues show that women with certain personality characteristics in middle age were twice as likely to have Alzheimer’s nearly 40 years later.

MORE: New Research on Understanding Alzheimer’s

“Getting Alzheimer’s disease is some sort of sum of a lot of different damages to the brain, and different things happening to the brain,” he says. “[Personality] is one of them.”

Specifically, a suite of features linked to what mental health experts call neuroticism showed the strongest connection to Alzheimer’s. Skoog and his colleagues tapped into a database of health information involving 800 women who were 38 years to 54 years old in 1968, when they filled in personality questionnaires and agreed to come in periodically to evaluate their cognitive functions. The personality evaluation placed women on a spectrum of neuroticism and extraversion; those showing more neuroticism included women who reacted more emotionally to events and experiences, worried more, showed lower self esteem and were more likely to express jealousy, guilt and anger. Those who were more extroverted showed high levels of trust, gregariousness and fewer emotional peaks and valleys.

MORE: New Insight On Alzheimer’s: What Increases Your Risk

At each of the four follow ups over the next 38 years, the women reported their stress levels—and women with higher neuroticism scores consistently showed higher levels of stress than those with lower scores.

Skoog believes that stress is the linchpin between the personality traits and Alzheimer’s dementia; previous studies have connected stress to dementia, and he says that the neuroticism characteristics are highly correlated to stress. “It seems like the personality factor makes people more easily stressed, and if people are more easily stressed, then they have an increased risk of dementia,” he says.

What’s more, when he controlled for the effect of stress, the association between neuroticism and Alzheimer’s disappeared, strengthening the idea that personality may lay a foundation for being more vulnerable to the effects of stress. Higher stress, particularly if it’s persistent as it is with certain personalities, can bathe the brain in hormones like cortisol. Those can damage blood vessels and cells in the brain that can then make Alzheimer’s more likely.

MORE: Scientists Are Getting Closer to a Blood Test for Alzheimer’s

The results hint that people can lower their risk of Alzheimer’s not just by keeping the brain active and improving social connections, as earlier work suggests, but by addressing stress-related personality factors as well. That, however, may require being aware of your later Alzheimer’s risk as early as during childhood, when personalities are forming. “Personality is something that occurs early in life, but you may be able to do something about it,” says Skoog. Especially when it comes to stress and how people respond to stress, interventions such as psychotherapy, for example, can help people to cope in healthier and less harmful ways.

He doesn’t believe that addressing stress and traits like jealousy and worry alone will protect a person from developing Alzheimer’s, but, he says, “it’s important to try to find as many factors as you can that contribute to common disorders. The more factors we can do something about, the more we can reduce risk quite substantially.”

TIME Aging

‘Senior Moments’ Could Be Early Signs of Dementia: Study

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Scientists hope that early identification of warning signs may help prevent memory problems from becoming so severe

So-called senior moments, like failing to recall your missing sunglasses are perched on your head, might not be just benign mishaps, but early harbingers of Alzheimer’s disease, reports a new paper.

The study, published in the journal of the American Academy of Neurology, suggests that self-reported worries about memory lapses are strong predictors of a later diagnosis of dementia. The research indicates that it takes about 12 years from initial signs of forgetfulness for the problem to become severe enough to be called dementia.

Of course, forgetfulness is a natural part of aging, and a spotty memory by no means guarantees that bigger problems are in the works, the researchers say. However, that does not mean concerns about errant sunglasses should necessarily be brushed off.

That’s because “there may be a significant window of opportunity for intervention before a diagnosable problem shows up,” Richard Kryscio, the study’s lead author and associate director of the Alzheimer’s Disease Center at the University of Kentucky, said in a statement. “Certainly, someone with memory issues should report it to their doctor so they can be followed.”

Right now, there are no definitive ways of preventing dementia, though early research suggests that a healthy lifestyle — including exercise, good eating habits and abstention from smoking — might help ward off the disease, the National Institutes of Health says. Antianxiety drugs have also recently been fingered as possibly increasing a user’s risk of developing memory problems later in life.

In the study, scientists at the University of Kentucky asked 531 people, average age 73 and without dementia, if they had noticed any changes in their memory in the past year.

People who reported such changes were about three times more likely to develop dementia than those who reported no such symptoms. In fact, of the 1 in 6 participants who developed dementia, 80% of those first reported memory changes.

Meanwhile, separate research published in Cognitive and Behavioral Neurology suggests that people with dementia may not remember specific events, like a visit from a relative, but do remember how those forgotten events made them feel.

“This confirms that the emotional life of an Alzheimer’s patient is alive and well,” Edmarie Guzman-Velez, lead author and a doctoral student in clinical psychology at the University of Iowa, said in a statement. “Our findings should empower caregivers by showing them that their actions toward patients really do matter.”

In the study, 17 people with Alzheimer’s disease and 17 healthy participants were asked to view 20 minutes of sad and happy movies. About five minutes after each movie clip finished, participants took a test on what they’d watched: though participants with dementia remembered much less about films than did the nondementia participants — one didn’t remember watching any movies — they still reported heightened levels of either sadness or happiness for up to 30 minutes after watching the films, according to the research.

In general, the researchers said, sadness lasted longer than happiness.

TIME Developmental Disorders

3 in 10 Former NFL Players Will Get Alzheimer’s, Dementia

Percy Harvin
Seattle Seahawks wide receiver Percy Harvin (11) reacts after taking a big hit during an NFL Divisional Playoff game against the New Orleans Saints on Jan. 11, 2014. Kevin Terrell—AP

That's at least twice the rate at which the general population experiences the same diseases

Nearly 30 percent of former NFL players will develop brain conditions like Alzheimer’s or a less debilitating form of dementia, according to a report released Friday by the NFL and the NFL Players’ Association.

The data in the report was used to calculate the size of a $675 million pool that will be provided to former NFL players who suffer from brain problems as a consequence of their time as professional athletes. The information was provided to the federal judge overseeing a lawsuit against the NFL on behalf of former players.

The report said that the rate of brain conditions for former players were “materially higher than those expected in the general population” and diagnosis occurred at an earlier age, according to an Associated Press report.

The terms of the settlement provide $675 million for treatment of former players, $75 million for neurological testing and $10 million for research. The judge overseeing the case expressed concern that the funds might not be sufficient to cover the estimated 6,000 former players who may suffer from brain disorders.

[AP]

TIME Aging

Eating Fish Makes Your Brain Healthier, Study Says

A customer eats bonito and horse mackerel sashimi (raw fish) at a high-end sushi restaurant in Tokyo on July 16, 2013.
A customer eats bonito and horse mackerel sashimi (raw fish) at a high-end sushi restaurant in Tokyo on July 16, 2013. Yoshikazu Tsuno—AFP/Getty Images

A helping of fish every week goes a long way

Eating fish is linked to more gray matter in the part of the brain that controls memory, according to a new study.

As the number of people suffering from dementia and Alzheimer’s continues to grow, identifying lifestyle modifications that benefit the brain is a popular area of research. In the study, published in the American Journal of Preventive Medicine, researchers looked at 260 people who reported their diets and underwent MRI scans, and discovered that those who ate baked or broiled fish weekly had more gray matter in their brains, which could mean better memory (sorry, fried fish sticks don’t count).

Interestingly, the researchers actually did not find an association between how the brains looked and the levels of omega-3 fatty acids in the participants’ blood. Prior studies have found that omega-3 fatty acids, commonly found in foods like fish and nuts prevent brain decline, but more recent research is questioning their effect, since omega-3 supplements do not always have an effect on memory loss. The researchers concluded there are likely other perks from eating fish besides their omega-3s.

The findings, like many others before this study, show that lifestyle behaviors really do matter when it comes to memory and overall health.

TIME Mental Illness

Depression Is a Risk Factor for Dementia, New Research Says

The two have been linked before, but the new study says depression may be an independent risk factor for the disease

The link between depression and dementia is puzzling for researchers. Many studies have noticed a correlation between the two diseases and a 2013 review of 23 studies of about 50,000 older men and women reported that older adults suffering from depression were more than twice as likely to develop dementia and 65% more likely to develop Alzheimer’s. But these have often only been associations. The newest study, published Wednesday in the journal Neurology, takes it further. The researchers believe that their findings, while not definitive, show that depression is in fact an independent risk factor for dementia — and not the other way around.

Researchers looked at 1,764 people with no memory problems around age 77 and followed them for about eight years. They discovered that people with mild cognitive decline as well as people with dementia were likely to have higher levels of depression symptoms before they were diagnosed, and that having these symptoms was associated with a greater decline in memory. Depression symptoms, the researchers estimated, accounted for 4.4% of the difference in memory decline that could not be caused by brain damage.

The reasons for the link between the two diseases are more unclear. Some research suggests that people with depression may have high levels of hormones that interfere with the region of the brain responsible for learning and memory aptitude. Gary Kaplan, an osteopath who runs the Kaplan Center for Integrative Medicine, as well as a handful of other researchers, has another theory: that inflammation caused by hyperreactivity of immune cells can hinder blood flow to — and impact neural pathways in — the brain.

Kaplan, who was not involved in this research, views depression as a symptom of inflammation in the nervous system, and not a disease in itself. “Depression is manageable,” says Kaplan. “We can modify risk for depression by lowering neuroinflammation. And these findings are completely consistent with depression as an inflammatory disease.”

It’s also possible that depression adds stress to the brain, and that can play a role in its deterioration.

If it was possible that treating depression could curb dementia risk, that would be game changing, medically speaking. That hasn’t been proved yet, but it’s an active area of research. The Mayo Clinic recommends that patients opt for treatments that are safe for both issues — for instance, taking antidepressants for depression, though “these medications may not be as effective at treating depression with Alzheimer’s as they are at treating depression alone,” they write. Kaplan thinks treating depression can be done with practices like meditation and getting more sleep — activities thought to calm the brain and improve overall brain health.

If the new research is right, finding new ways to treat depression may have an impact on dementia risk — even if it’s small.

MONEY Aging

Help for People Who Can’t Handle Their Money Anymore

Younger person assisting elderly client.
Gary John Norman—Getty Images/Cultura

A daily money manager can pay bills, keep spending under control, and protect a client from scams.

Martha Nurenberg knew her 86-year-old father, Paul, had a problem when he was almost taken in by a letter promising untold riches if he provided a bank account number and payment of legal fees for a money transfer.

Though Paul never sent any money, he did answer the letter with interest.

As dementia set in, Paul could no longer remember the password to his computer where he kept his financial records. Then Nurenberg received a call from the director of her dad’s senior living facility, who said Paul had not paid his last two bills.

“We realized that he couldn’t keep the financial records anymore,” says Nurenberg, who runs the AARP’s employee volunteer program in Washington, D.C. But neither she nor her three siblings lived anywhere near their dad’s facility in Middlesex, N.Y. Nor did their mother, who is also suffering from dementia, know anything about the complicated records her husband kept.

So they called a professional, Jacquelyn Bell, a Rochester, N.Y.-based CPA who wears a second hat as a daily money manager for clients such as the Nurenbergs. Instead of just filing quarterly or annual tax forms, Bell receives her clients’ mail, pays their bills, balances their checkbooks and helps them keep to a budget if they are on a fixed income.

For the families of the more than 5 million Americans suffering from Alzheimer’s or another form of dementia, such hands-on services can be a necessity. “Most of my clients fall into a few categories — no family or children, have children but not local, children are too busy, or elder financial abuse,” says Bell.

CHOOSING AND USING THE RIGHT MANAGER

Demand for daily money management services as America ages is likely to grow significantly, but at least for now the profession is virtually unknown. The American Association of Daily Money Managers (aadmm.com), the profession’s primary trade group, has only about 700 members nationwide.

What is more, no government agency regulates daily money managers, even though they have access to clients’ sensitive financial information. For this reason, properly vetting a potential manager is essential. That means asking for references from other clients, and, when possible, checking with state professional licensing boards for credentials and for such things as malpractice.

The AADMM provides certification to daily money managers and lists of credentialed members. This guarantees at least a certain level of proficiency in the field.

To avoid fraud, be sure to establish certain safeguards. Money managers should provide monthly reports of all their financial work, including copies of bills paid, if requested. Some clients create a bank account specifically for the money manager that has limited funds, just enough for the monthly bills and a small amount left over.

Meanwhile, the rest of the client’s money is off limits.

EXPERTISE

Bill paying alone is usually not all that hard, but if health, long-term care or other complex issues become part of the mix, expertise may essential.

That is where someone such as Sheri Samotin may come in. Prior to founding her daily money management business, LifeBridge Solutions, in 2009, she spent some 25 years in the healthcare industry, much of it as a manager of a medical practice where she often negotiated with health insurers unwilling to pay claims. She is familiar with the complex codes hospitals and insurers use for medical procedures, including what is covered and what is not by different policies.

But if tax, estate or small-business issues are more of a concern, a CPA such as Bell would likely fit the bill.

TRUST

Also, since trust is such an important factor, ceding power to a manager all at once may not be wise. Initially, Nurenberg’s father would sign all the checks Bell was writing for the bills so he had a chance to review them. As he deteriorated, Nurenberg, who had power of attorney for her parents, signed them. Now Bell, having proven herself, handles everything.

Dementia or other disabilities are not the only reasons to hire a money manager. Parents often hire managers to handle the affairs of their mentally disabled children’s estates after they are gone.

Addictions are another reason. Bell has shopaholic and gambler clients whose checkbooks she keeps in her safe so they cannot get to them.

For many the service can be a matter of convenience. “While mom’s very capable of paying her bills, this lets her focus on enjoying her retirement,” says Mitchell Dannenberg, a Naples, Fla. insurance salesman who hired Samotin to handle his mother’s finances.

Costs of daily money managers vary depending on the services required and your location. Bell charges $90 an hour but says services can cost as much as $150 a hour in pricier New York City. Some clients only require an hour of service a month while others need five to six, she says.

It is not cheap by any means. But for Nurenberg, Bell is more than a financial security blanket. She is a “godsend,” Nurenberg says.

TIME Research

In 2025, Everyone Will Get DNA Mapped At Birth

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What will the future hold? REB Images—Getty Images/Blend Images

Scientists have scoured trends in research grants, patents and more to come up with these 10 innovations that will be reality in 10 years (or so they think)

Everybody likes to blue-sky it when it comes to technology. Driverless cars! Fat-burning pills! Telepathic butlers! But the folks at Thomson Reuters Intellectual Property & Science do it for a living—and they do it with data.

By examining who’s investing in what, who’s researching what and who’s patenting what, the group has come up with 10 predictions of innovation for 2025, which they presented at the Aspen Ideas Festival. The list included the first attempts at testing teleportation, the ubiquity of biodegradable packaging and electric air transportation.

Here’s what they say will be commonplace in medicine in a decade:

1. Dementia will be on the decline

While the World Health Organization predicts that more than 70 million people will be affected by dementia, much of it related to Alzheimer’s disease, by 2025, that upward trajectory of cases may be blunted somewhat by advances in genetics that will lead to earlier detection and possible treatment of the degenerative brain disorder.

2. We’ll be able to prevent type 1 diabetes

Unlike type 2 diabetes, which generally develops when the body gradually loses its ability to break down sugar properly, type 1 diabetics can’t produce enough insulin, the hormone that dispatches sugar from the diet. Advances in genetic engineering will lead to a more reliable technique for “fixing” genetic aberrations that contribute to type 1 diabetes as well as other metabolic disorders, making it possible to cure these conditions.

3. We will have less toxic cancer treatments

Building on the promise of targeted cancer therapies, which more precisely hone in on tumor cells while leaving healthy cells alone, researchers will have a deeper knowledge of the Achilles’ heels of cancer cells, which will help them to develop more powerful and precise drugs that can dispatch tumors with fewer side effects.

4. Every baby will get its DNA mapped at birth

It’s already a trendy thing to have your genome sequenced, but today there isn’t much you can do with the information. Having that information, however, may prove useful in the near future, both for predicting your risk of developing diseases as well as your ability to respond (or not) to certain drugs. As knowledge about the genome, and what various genes, or versions of genes do, grows, so will doctors’ ability to predict health outcomes and treat patients based on genetic information. So within a decade, getting a baseline DNA map at birth could be a valuable way of preparing to lead a healthier and possibly longer life.

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