Among new millennium’s top picks in the market, vaporizers are one of the most purchased weapons to fight against various diseases. Yes, not only smokers but also non-smokers are utilizing the benefits of vaporizer. It is a device that turns the herbal content into active vapor without giving rise to tar or harmful gases. This makes it ideal friend for those who genuinely want to quit smoking.

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Three kinds of treatments are currently in practice -

1. Behavior management
2. Drug therapy
3. Emotional support for the patient’s caregiver.

The last has been the most successful to date thanks to the untiring work of individuals and to the support provided by organizations such as the Alzheimer’s Association. Behavior therapy holds no cures but it offers great improvement in the day-to-day management of patients with Alzheimer’s disease and other dementia symptoms. For instance, Veronique Breuil and her colleagues at Hopital Broca in Paris have reported some behavioral benefits following a “cognitive stimulation program.”

Research on drugs that might enhance Alzheimer patients’ performance on memory and language tasks is moving at a rapid pace. A computerized search restricted to a psychology database revealed 262 studies involving drugs and Alzheimer’s disease just in the last ten years. A lot of work is being done with cholinesterase inhibitors (e.g., aminoacridines such as tacrine and velnacrine). These can prevent the rapid degrading of acetylcholine, an important neurotransmitter that Alzheimer patients typically have in reduced amounts. The logic is that a patient’s limited supply of acetylcholine would have a better chance of doing its job if it can be kept from depleting so rapidly. There is also a lot of encouraging research on the memory benefits of glucose, and some promising work on delayed onset of symptoms with anti-intammatories. With the number of new drugs being developed, the need is even stronger for better tests to positively identify Alzheimer’s disease.

As Dr. Hutton discussed in his treatment of the medical aspects of dementia there presently is no single known cause or any associations of lifetime events that lead to the specific type of dementia known as Alzheimer’s disease. There are only theories suggesting cause­and-effect relationships, which provide some direction for future research. Since we are what we eat, a legitimate question is, “Does diet alone, in any way, contribute to the onset of Alzheimer’s disease?” The answer to this question is most certainly no. It is possible, however, that some dietary components of food, over which we have no control, may participate in the disease once it has begun.

The most studied dietary component observed to be associated with Alzheimer’s disease is aluminum. It seems clear that aluminum does not cause Alzheimer’s disease. After all, many people use aluminum cook ware, and we store foods in aluminum containers. Aluminum is a major component of numerous antacids and deodorants, and many foods naturally contain aluminum. The mineral is also abundant in the soil, normally nontoxic, and has no known nutrition function. Aluminum accumulates in the brain plaques of Alzheimer patients as the disease progresses. The concentration of two other minerals, silicon and calcium, have also been observed to be concentrated in the brain plaques. Bromine and nickel, two more nonessential dietary components, have been found to be elevated in the blood and spinal fluid of a small sampling of Alzheimer patients. While the source of these minerals is probably dietary, at this time the evidence is insufficient to conclude that common dietary practices contribute to the onset of Alzheimer’s disease.

Muscle, Bone, And Joint Benefits

At least two significant advantages of exercise accrue to the musculoskeletal system. One is that with increased muscle endurance, muscle fatigue is reduced. Another is the treatment and prevention of osteoporosis. The latter is a decrease in bone mass or density that comes with aging and is particularly prevalent in women after menopause.

Although the reversal of osteoporosis is not to be expected, its progression can be stopped. There are physicians who believe that some rebuilding of bone may occur with proper diet and exercise. Ten percent of women age fifty have suffered broken bones due to osteoporosis. By the age of eighty, 25 percent of all women have sustained hip fractures. Studies both in experimental animals and humans have indicated that physical activity slows or prevents bone loss that occurs in many menopausal women. Osteoporosis is facilitated by decreased activity, decreased hormones, and inadequate diet (low caloric and calcium intake). It has been shown that exercise can be of benefit even without changing diet or hormonal states, although a comprehensive treatment program would address all three areas. It is noteworthy that the average adult needs 1500 mg. of elemental calcium per day. It is very difficult to obtain this level of calcium in the diet. Therefore, one should consider augmenting one’s diet with a calcium supplement. It is vital to understand that we speak of elemental calcium. The total weight of the calcium compound is given on the label of medications, but the level of elemental calcium can also be found on the label.

It is important when discussing the bone, joint, and muscle benefits of exercise that emphasis be given to stretching exercises, which are a vital part of every comprehensive exercise program and may be even more important for the demented patient. Stretching exercises ensure increased flexibility of the joints, which may help to prevent injury (i.e., reduces risk of falling). Stretching exercises also improve coordination and efficiency. There is an increase in strength of the tendons, and the bone is stronger because of repetitive use.

Heart And Blood Vessel Benefits

It is generally accepted that the most important heart and blood vessel benefit that comes about from regular exercise is increased usage of oxygen,. which improves heart muscle efficiency and decreases the likelihood of hypertension (high blood pressure). The best overall way to measure fitness is to measure maximum oxygen uptake, or the amount of oxygen that can be used in a measured period of time. An exercise program helps the use of oxygen by increasing the heart’s output, and also by increasing the usage of oxygen by the muscles and other organs. Exercise brings about a decrease in the resting systolic blood pressure (the pressure when the heart beats) and diastolic blood pressure (pressure between beats). This reduction of blood pressure is better when it can come about by what has been called hygienic means such as exercise, reduction of weight, decreased salt intake, and psychological behavioral treatment rather than by the use of medication.

Several programs have been instituted since the 1950s to provide better housing and facilities for the elderly. However, many housing facilities have been designed and constructed with little knowledge of the biological characteristics of aging persons. Additionally, most policies and standards relative to the design of buildings by architects, environmental planners, interior designers, and others have been formulated on the basis of assumption, rather than information obtained through systematic research that includes user needs. As a result, living environments frequently are not responsive to the needs of older people, particularly persons suffering from dementia of the Alzheimer type. Several environmental variables, including illumination, noise abatement, color, furnishings, spatial arrangement, pattern, and texture are consistently deficient. Anyone of these features, if problematic or inappropriately applied, can further complicate the life of an individual experiencing dementia. Certain environmental design features may not only threaten the person’s health, safety, and welfare, but produce anxiety that can amplify cognitive deficits and result in negative behavioral responses.

Useful Tips

Creating a therapeutic environment for the Alzheimer patient is a complicated task for both caregivers and designers. A user-friendly approach in arriving at design solutions must be used in order to design living environments that meet the specific needs of the individuals who are cognitively and/or physically impaired. The design suggestions are broadly stated to allow caregivers and designers creative latitude. Materials selection and color preferences should be determined by the designers and caregivers based on geographic location, the type of housing facility, codes and regulations, climate, topography, economic constraints, and future plans. These suggestions are not conclusive and much remains to be learned in this area. What may be the most important concept in designing is to attempt to perceive the world through the eyes and ears of an Alzheimer patient. Continue to think of ways to maintain familiarity, reduce confusion, and still provide a pleasant and appropriate living environment for these special individuals.

Like many Alzheimer patients, as Mr. Jones’s disease progressed, alter ations in nutrition were noticed, there was a significant weight loss. It became important to assess food likes and dislikes, to determine if he was able to feed himself, and to ascertain the nutritional value of the food he was eating. It was also important to determine if loose or missing teeth affected his nutrition. Ms. C. was advised to limit the number of choices that he could make, since his ability to decide was impaired. She was encouraged to give assistance with food selections as appropriate. To further encourage adequate intake of calories, Mr. Jones was allowed sufficient time for meals, and privacy was provided so that he was not embarrassed by unacceptable eating habits. Finger food or foods that could be eaten with a spoon were provided because they were man age able and allowed him to be autonomous in his feeding. When Mr . Jones refused to eat adequately at mealtimes, small, frequent feedings were offered. Food supplements (such as Ensure) were used alternatively to assure proper nutrition for Alzheimer treatment.

Methods Of Improving Nutrition

• Provide assistance with food selection as appropriate.
• Ensure privacy so the person is not embarrassed by unacceptable eating habits that may develop.
• When the patient refuses to eat regular food, consider using food supplements.
• Monitor the amount of fluids consumed.
• Offer frequent, small feedings.
• Limit the number of food choices, since decision-making is impaired.
• Since the patient’s motor functioning has decreased, allow sufficient time for meals.
• Provide finger foods or foods that can be easily managed with a spoon.
• Allow the patient to be as autonomous as possible in feeding.
• Avoid extremely hot foods guard against burns.
• Monitor weight at least once per week at the same time, preferably in the morning.

It proved helpful to listen attentively and to maintain eye contact while communicating with Mr. Jones. Approaching in a calm, pleasant manner, and speaking slowly and distinctly worked well to facilitate understanding. Ms. C. was advised to avoid confrontations when possible. Despite Mr. Jones’s poor ability to communicate, it was very important that Ms. C. continue to spend time with Mr. Jones, talking with him and helping him feel related to others.

Methods To Improve Communication

• Speak slowly and distinctly.

• Approach in a calm and pleasant manner.

• Keep directions simple: use simple words and short sentences.

• Listen attentively and maintain eye contact.

• Offer appropriate praise when meaningful statements are made.

• Avoid confrontations.

• Select a time of day when the person is relaxed, then engage in conversation.

• Call the patient by name, often response is forthcoming when the first name is used, at least until the last stages of disease are reached.

• Provide objects to assist with orientation (i.e., clocks, calendars, etc.).

Once a patient is suspected of having Alzheimer’s disease, comprehensive physical, radiological, and neuropsychological examinations will likely be performed by the attending physician. A full nutritional assessment may also be warranted at this time. Since Alzheimer’s disease is a slow, progressive illness, many patients will at first appear in excellent physical health. Severe dementia brought on by nutritional imbalances or deficiencies is rare, but some instances of mental impairment among persons over the age of sixty have been associated with lower-than-average vitamin intake or an inability to utilize certain vitamins. A physical examination and nutritional assessment will likely exclude the possibility that the dementia has a dietary origin.

The gradual mental decline usually associated with Alzheimer’s disease is typically accompanied by physical decline of the patient. Such decline is the combined result of neuromuscular impairment, a reduction in ability to exercise, and inadequate nutritional intake. Confusion, gradual loss of short-term recall, and a shortened attention span may result in the Alzheimer patient not completing or even skipping meals. Selecting the proper eating utensil may become a difficult and frustrating mental task. The caregiver will eventually have to make what appear to be simple decisions for the Alzheimer patient.

Meals skipped, excessive irritability, and reduced sleeping hours over extended periods of time may place the Alzheimer patient in a continual negative calorie condition. Under such eating conditions, protein-calorie malnutrition may occur, and the patient will begin to lose weight. It seems reasonable, therefore, that attention to the patient’s weight and caloric intake are the first defenses that a family can take against the physical deterioration associated with Alzheimer’s disease.

Reduced caloric intake and weight loss lead to reductions in both vitamin and mineral intake, even if smaller amounts of a balanced diet are eaten by the patient. Protein-calorie malnutrition hastens vitamin/mineral deficiencies unless a vitamin/mineral supplement is provided. However, there are no data suggesting that vitamin/mineral supplements either retard or accelerate the course of Alzheimer’s disease. Caregivers should consult with the attending physician concerning use of a vitamin/mineral supplement.

Protein-calorie malnutrition is frequently encountered in elderly patients in hospitals and other institutional settings as a condition secondary to the primary disease. Inadequate food intake frequently arises from mental decline, loss of physical dexterity, difficulty in swallowing, and the need to be spoon-fed by a caregiver. Without necessary caloric intake, vitamin/mineral deficiency can lead to impairment

of the immune system or the blood. The immune system is responsible for combating infectious disease, including pneumonia, which occurs frequently in Alzheimer’s patients. Impairment of the blood system may result in anemia, thereby further weakening the patient.

During the advanced stages of Alzheimer’s disease, the patient’s family may be confronted with the decision to provide nutritional support therapy by nasogastric tube or total parenteral nutrition (TPN), administered through a tube into the esophagus or stomach. Such decisions, often difficult to make, usually reside with family members after consultation with the attending physician.

Protein-calorie malnutrition associated with vitamin/mineral deficiencies and dehydration are frequent consequences of Alzheimer’s disease. Vitamin-mineral deficiencies are readily preventable through the course of the disease by providing solid or liquid supplements. Dehydration can be prevented by noting sufficient consumption of liquids. Protein-calorie malnutrition is more difficult to prevent. Increased family awareness of nutritional aspects, professional assistance, and more attention to the nutritional management of the Alzheimer patient may slow the rate of mental and physical decline of the Alzheimer patient.

What is family therapy? There are many different models of treatment for families in distress, and it is beyond the scope. In most models of family therapy, all the members of a nuclear family are seen in a group session with one or two therapists or counselors. In some models, only one or two members may be seen, and the treatment is considered to be family therapy because the focus of discussion is on family relationships. At times, members of the extended family may also be involved in treatment, especially if they are closely concerned with the problems, as is often the case in families where there is neurological impairment of one of the older members. Treatment sessions are typically held weekly for ninety minutes, although they may be spaced more widely apart. In one model, families are brought in for an initial two-day treatment session and then brought back several weeks or months later to follow up on the treatment and to make further interventions if necessary. This is a useful model for families where members are spread over a wide geographical area.In most models, family relationships are treated, rather than anyone individual in the family, although frequently one person is the identified patient. In the family with a neurologically impaired member, the other members may define the demented individual as the patient or they may define one of the other family members as the dissatisfied one, i.e., the problem for everyone else. On the other hand, the family may come into treatment all acknowledging their distress, and ask for coping skills. In the early stages of treating families with a neurologically impaired member, the interventions may involve education about expectations of the impaired person, prognosis, and coping skills. However, treatment may need to go beyond education in order to maximize the well-being of both the family and the demented patient.

According to one model of family therapy, inappropriate behavior patterns are the result of family members oversensitivity to and compliance with one another’s needs and wishes to the detriment of their own development as individuals. Therapy sessions seek to demonstrate such entanglements. For example, some grown children may cope with a demented mother by avoiding her, while one daughter may respond to her brothers and sisters un involvement by becoming totally involved in caring for the mother, even to the point of neglecting her own nuclear family (i.e., her husband and children). She may resent her siblings’ lack of involvement at the same time that they feel guilty about abandoning their sister and their mother. Or, more subtly, the caregiver may shield the other family members from discovering the extent of their relatives impairment, protecting them from a fact that they do not want to face. As a result, the caregiver prohibits herself from confiding in others about her feelings or asking for relief from her duties, and/or the rest of the family criticizes her when she does complain because they believe there is so little to complain about.

Family treatment would consist of demonstrating such patterns of protection, thereby helping family members to perceive their own feelings and roles in creating and maintaining such patterns. Therapy consists of helping family members to gain insight into maladaptive entanglements and to develop new, more adaptive patterns. In another treatment model, families are viewed as having problems because they do not communicate straightforwardly, often using complicated communication patterns to maintain control over other family members. For example, one rather uninvolved member of a family may criticize the caregiver for discussing the possibility of putting the impaired member into a nursing home, the implication being that the caregiver does not love the patient. This may be an effort to handle personal guilt about abandoning the family member by attempting to keep the patient in the caregiver’s home. Therapists may attempt to change levels of communication to more straightforward patterns by showing the family how to communicate well. Then again, therapists may engineer changes in one person’s behavior that will automatically change the whole family’s way of communicating.

Yet a third treatment model examines the family members’ ways of communicating rather than what they communicate to each other. For example, members of the family may communicate only with each other, rather than with nonmembers, as in the case of a family that will not allow its members to let outsiders know about its problems, even when there is a desperate need for expert help. Yet the family itself may not ever resolve the problem, so that one or more of the members eventually feels great distress. Such a family would be said to be too enmeshed or intertwined with one another and too separated from the rest of the world. Certain particularly troubled families have been found to avoid seeking outside help with problems revolving around caring for an Alzheimer patient.

Therapy within such a framework involves helping the family to restructure itself to deal more effectively with the current situation, bringing in outside help if necessary. If the family is not enmeshed, but disengaged (that is, not sensitive enough to each other’s communications), members may need help to restructure their relationships to be closer. Typically the therapist helps the family to change by engaging in exercises that give them practice in seeing current ways of communicating and in using new patterns of communication. For instance, the barriers between two subsystems may be too rigid for messages to pass across, so the therapist may ask one of the members to sit next to another member and to address him or her directly.

Studies have not uniformly shown family counseling to be successful in alleviating problems associated with caring for Alzheimer patients. For instance, family counseling focused on problem solving has sometimes yielded poor results. However, at least one study reported the success of family counseling in which the caregivers were taught to communicate their needs and the family to listen sensitively and to give emotional as well as practical support.

Although half of all dementias are caused by Alzheimer’s disease, it is critical that other possible causes for impaired functioning in the elderly patient be evaluated and ruled out before caregivers and/or family members attempt to undertake enhancement programs. As the public becomes more aware of Alzheimer’s disease, the danger of non­professionals making a diagnosis increases, and with it, well-intentioned but often inappropriate attempts or suggestions at management. If appropriate medical investigation is conducted, this should not be a problem, since a diagnosis of Alzheimer’s disease in part depends upon a systematic exclusion of other dementing diseases, some of which are treatable or reversible.Even where Correct diagnosis is made, the caregiver should be alert to changes in the patient’s thinking, speech, or emotions that may not be a true component of Alzheimer’s disease. In some cases, such changes may reflect other, modifiable conditions, which, if taken into account, would reduce some of the confusion or disorganization that occurs in the demented patient. For example, demented individuals are vulnerable to delirium, which typically can be recognized as a sudden and obvious change in the patient’s normal mental functioning. Delirium may have symptoms that are very similar to those of Alzheimer’s disease, e.g., impaired alertness, slow and confused thinking, and difficulties in shifting or maintaining a focus of attention. However, these symptoms can result from various physical ailments or reactions to medicines.

In addition, depression mayor may not be present in the Alzheimer patient at a particular point in time. When present, depression can make impaired memory function even worse, reduce the patients interest in the surrounding environment and in others, further compound difficulties in regulation of sleep, and even result in a full-scale withdrawal into a completely incapacitated vegetative state.

These considerations reflect that while Alzheimer’s disease is progressive, the rate of progression and the way that the impairments show themselves may vary greatly across individuals and may be influenced by factors such as depression and toxic drug reactions. Though many strategies will be discussed here, it will be important to keep in mind that any management approach involves frequently changing interactions between the Alzheimer sufferer and the relative or caregiver. This is because the condition may vary from day to day and worsen over time.