2023 Dementia Summit Q&A
Dr. Pat Zook MD has answered the questions submitted by attendees
Dementia Summit Q&A:
Q: In Danish elderly homes, the rate of elderly with dementia is exploding. These homes can be a good control environment to practice healthy nutrition that promotes ketosis and reduce sarcopenia. Yet, the elderly feed on grains, breads and juices, daily, and absolutely nothing is being done to curb dementia. What would be your advice to these Danish elderly homes? Any direct message to the elderly patients and their caregivers?
A. If you mean in Denmark the country, their food choices are likely mandated by national standards. If you mean Americans living in long term care homes, then their food offerings are also mandated to some extent. But family can bring in their own food choices and make suggestions to the nursing home staff. Ask for a low carb diet for your loved one. Protein snacks that are easy include nuts, hard-boiled eggs, yogurt cups, cheese sticks, but be sure to offer adequate water to drink with these protein snacks.
Q. Does chronic vitamin deficiency or diet have anything to do with the development or advancement of ALZ? How can more preventative care and screening be available to family members of those who died of Dementia/ALZ?
Our Dementia Resource Center Clinic in St. Cloud does consultations for anyone wanting to learn how best to delay/prevent dementia. Our website has several suggestions and the video of our May 4th Summit should be available on the D-CAN website soon.
Q. Is there existing solid evidence of hereditary pre-disposition for dementia? If so, what is the percentage?
Only about 2% of dementias are solely hereditary and usually in people much younger than 65. Why dementia seems to “run in a family” involves family-learned health habits like smoking, using alcohol, lack of exercise, poor social skills. Also, you can inherit several dementia risk factor conditions like diabetes, high blood pressure, coronary artery disease, and so forth, which can lead to more risk of dementia.
Q. Are there counselors who work directly with people who have dementia? It can be such a difficult time for them emotionally.
Yes, D-CAN will be launching their dementia-informed counseling for patient-caregiver couples that have hit a tough time in their relationship (even after 50-60 years of marriage) because of the dementia symptoms. Also, social workers can be very helpful for this.
Q. What about the “brain health pills” that are out? In your opinion (Dr. Zook), are they worth it?
If you mean the over-the-counter meds like Prevagen, etc. I don’t see any harm trying them, but I am skeptical about their effectiveness, but some people say that they had improvement using them. If you mean the expensive prescribed intravenous, 4 times a year drugs that remove Beta amyloid and costs $28,000 or more per year just for the medicines and that requires 4 brain MRI’s yearly and that has now been shown to cause brain shrinkage in several cases – then no, I’m not thinking that this is where we should be going to “treat” dementia.
Q. Managing safety of others when working with clients who have increased agitation and delusional thought process.
This kind of care can be scary at first for caregivers alone with the client at home or in a nursing home, but with experience and training there are many non-drug methods to learn that can help in most of these situations.
Q Are you aware of any in depth dementia training for hospital staff when it comes to patient dementia “behaviors”, what standards do hospital have for dementia care/training?
There are many online learning opportunities regarding managing behaviors. Alzheimer’s Association offers several on their extensive website. Then just look around on the Internet for video’s on dementia behaviors management – preferably from a well-known learning institution.
Q. How likely is it that an 82 year old male with moderate dementia (diagnosed with Parkinsonism but not diagnosed with Parkinson’s Disease) will be able to live out the rest of his life at home? He is able to dress himself, eat by himself when served, make a sandwich when alone, walks slowly, experiences joint stiffness and occasional dizziness, has occasional incontinence but usually toilets himself, does not go out or wander off, is content to just sit, and sleeps well. He is nonthreatening to others and himself and doesn’t mind staying home alone for several hours. Is all this likely to change gradually or overnight or is there no such thing as likely?
First, we recognize and thank you for your caregiving service. Every case is unique, but if you call either of our care navigators at the DRCC office, I’m sure they would be happy to discuss your situation. Predictions without more information would be difficult, but Tami or Cristina may be able to help.
Q. Are health insurance companies supportive of dementia costs and medications and for the cost of home or support for family caregivers? How is it best to access this information?
Our experience with Medicare and medical insurance companies shows that neither of them is supportive of paying much for medical services in general but particularly so for anything new in medical services that are innovative and without many years of the same as always. It will be part of the D-CAN mission to demonstrate the effectiveness of our DRCC services to Medicare and medical insurers before we can expect adequate reimbursements.
Q. What are we doing to assist those that are not able to attend support groups, education, or skeptical of asking for help what resources are available in the community? I.e. Bringing hope and support to their lives.
Our nonprofit, D-CAN will be collaborating with faith group leaders to see if their community’s acceptance of dementia support might prove to be an effective approach to help those reluctant or skeptical folks who still need support. Some faith group organizations already have “parish nurses” or similar volunteers dedicated to helping members with various medical problems.
Q. What recommendations do you have to offer support to individuals with dementia who are incarcerated?
Our DRCC evaluation team has done “remote evaluations” without the person living with dementia actually coming into the clinic. We use caregiver/loved one’s input and paper chart information to do these and make several recommendations for the clinician to follow to optimize the person’s health. Also, we have dementia information on our website assuming Internet access is available.
Q. What are your thoughts on Methylene Blue and brain function?
Although I have no personal clinical experience with methylene blue, it does have several potential medical benefits to its clinical use. Be sure to discuss any possible personal use with your medical clinician.
Q. What are your thoughts on Gamma-Aminobutyric Acid and brain function?
I have no experience recommending over-the-counter GABA pills. This substance might also offer some calming effects but may not be absorbed very well in oral form and not much is known about side effects, best dosage or drug interactions. Be sure to discuss with your clinician before considering taking this drug.
Q. What are your thoughts on COVID and Shingles vaccines? Should we take them?
Immunizations were one of the most significant advances in medicine but we tend to minimize their life-saving importance in modern times. Bad cases of shingles can severely worsen the health of persons living with dementia and Covid can of course be fatal. I think we should get all recommended immunizations except for a few very rare exceptions.
Q. How do you know if a medication is water or fat soluble?
This is rarely of significance but easy to look up on the Internet for any class of drugs.
Q. What cooking oil do you recommend for cooking and baking?
Fruit oils are best – avocado and olive oil (assuming they are not counterfeit). Most other oils are seed oils like canola, corn and sunflower oils which have a lot of the less desired omega-6 fats.
Q. Do countries with socialize medicine do a better job treating dementia?
These countries are likely to stress the importance of quality of life for those living with dementia more than our US system of dementia care which continues to look for some promising blockbuster drug to solve this problem.
Q. What are the pros and cons of getting genetic testing?
Genetic testing for dementia-related genes can give younger family members of a dementia patient early warning regarding this dementia risk factor. However, without preparation for good vs. bad news some positive family members may not be able to handle any adverse genetic tendency for dementia with their results.
Q. How much Vitamin K should you have daily?
Be sure to ask your clinician if it is OK to take Vitamin K. It could interfere with a common blood thinner med. If no reason not to, and OK with your clinician consider taking 100 micrograms of Vit K2 twice a day after eating.
Q. Is it healthy to grind flax and chia seeds? I add it to my oatmeal.
I see no problem with this. Grinding them makes more fiber available to your good intestinal bacteria which has many benefits.
Q. What does vaping do to your brain?
Several of the things inhaled with various vaping products can have their own side effects including bad things for your blood vessels.
Q. Are you seeing an increase in dementia post-surgery anesthesia?
Not me, but I only see a small number of all those having had general anesthesia. The risk is more from having had numerous general anesthesia’s and not from any particular surgery. However, delirium (acute brain dysfunction) after surgery that lasts several hours or more is a strong dementia risk factor if no other cause of the delirium is found.
Q. What about hydroponic greens and Nitric Oxide? Are they not good vs. greens raised in good farm soil?
Good question. The important thing is the nitrate and nitrite content of the greens. This can vary widely one state to another. Greens with low nitrate or nitrite will not help you blood vessels produce much nitric oxide. Ask to have the greens tested at U of Minnesota for nitrate and nitrite content and compare the results to US averages.
Q. How important is drinking water for brain health?
Dehydration can hurt brain function especially when overheated and with exertion. Our thirst sense becomes less able to tell us when we need to drink water as we get older – especially someone living with more advanced dementia. Urine frequency and color (pale straw color) are simple ways to help decide if we are drinking enough water.
Q. What doctors in the St. Cloud area deal with dementia?
Neurologists, internists, family physicians and several nurse practitioners and physician assistants regularly see patients with dementia. We at the DRCC of course also see dementia patients.
Q. Comment on dental procedures, such as implants- Does any dental work affect us cognitively? Studies done?
There are several studies covering dental problems vs. dementia risk. The procedures themselves do not have much effect but if gums become inflamed or infected before or afterward, especially the slow smoldering kind of infection, then this inflammation is more likely to hurt cognitive function if going on for a long time.
Q. Why no Listerine? Is there a certain ingredient to look for?
Its not any particular ingredient. It’s the fact that you kill good mouth germs if the mouthwash is antiseptic (it kills all germs good and bad). We need the good mouth germs to help our bodies make nitric oxide for good blood vessel health.
Q. What sugar substitute do you recommend?
None really. We need to withdraw from our sweetness habit. These artificial sweeteners are way too sweet making withdrawal very difficult. Most of these hurt the good germs in our intestines and several can make us eat more.
Q. Will insurance cover if my doctor writes a referral?
If you mean cover our DRCC evaluations, we still accept what insurance “pays” but since this is so little, we may have to eventually charge cash when a particular insurance agency refuses any reimbursement at all for our services. We have not done this so far however.
Q. Are beets good for you?
Beets do offer high levels of nitrate and nitrite that can help our bodies make more of the good nitric oxide for our blood vessels.
Q. Is there an alternate treatment for severe acid reflux other than ppi?
Several things may help including losing excess body weight, reducing sugar and starches in your diet, avoid overeating – ever, avoiding foods that make you “gassy”.
Q. Can you describe the different stages of dementia?
First normal with no disease or symptoms, then predementia when the chemistry is there but no symptoms yet, then subjective cognitive decline when you can tell something is wrong but you can still pass the cognitive tests, then mild cognitive impairment when you and loved ones notice your dementia symptoms, then mild dementia, then moderate dementia, then advanced severe terminal dementia, then death.
Q. Have you incorporated Faith Community Nurses/ Parish Nurses in your plans? (Education, referrals, plans).
Yes, in our DRCC plans – hopefully this year and similar plans for all faith groups.
Q. Besides B vitamins, what can we do to prevent dementia?
Please review our last May 4, 2023 Dementia Summit session on our Website under Events.
Q. Is brown sugar or honey any better?
Locally produced and harvested honey may have some health benefits, but honey and brown sugar are still pretty much sugar. The less the better. Try to wean yourself away from sweetness.