Passive-aggressive behavior disorder: Part 2

Features of the disorder include:

- Repeatedly putting things off
- Deliberately forgetting to do things
- Being stubborn and acting dumb
- Having intense dislike of people in authority
- Frequently complaining and whining about mundane things
- Intentionally working slowly
- Feel unappreciated and want to be constantly praised
- Always blaming others for their misfortunes
- Dislike novel ideas even when practical and useful
- Continuously arguing for no apparent reason

Treatment

There is no easy way to treat this disorder because the individuals are very stubborn and never see themselves as the problem. Unless someone forces them into therapy such as family, friends or employers, the behavior continues for life. These individuals have minimal insight into their negative behavior and always see fault in others. Some individuals may seek therapy after realizing they are not getting anywhere in life.

There are no drugs that can cure passive aggressive behavior. Counseling and supportive therapy do help, but relapse is common. In rare cases, anti depressant drugs may help control the negative attitude but many individuals are not compliant. When the individual is aware of his/her behavior, it is recommended that one stop drinking alcohol as it can make the negative attitude worse. Other methods which have yielded partial success include yoga, family and cognitive behavior therapy.

The prognosis for individuals with passive aggressive behavior is poor. Many end up lonely, isolated, become paranoid and develop depression.

Can Axona help prevent Alzheimer’s Dementia? Part 2

So where does the consumer stand with Axona?

There have been numerous dietary substances hyped up to cure or prevent dementia and none has so far proven to be effective. AD is a complex disorder with numerous physiological and neurological changes. Inability to utilize glucose by brain cells is just one more hypothesis. Now we have axona and its ketone building properties. If high levels of ketone were the panacea for treating dementia, then all type 1 diabetics would never develop dementia and this is not true at all. In fact, diabetics have one of the highest rates of dementia and other cognitive problems—so the ketone theory is hogwash. Secondly, high levels of ketones can cause very unpleasant symptoms. Thirdly, despite Axona being available on the market for some time, very little has been reported about it. There are only anecdotal reports by a few individual who seem to have reported improved symptoms after taking axona. There is not a single patient whose dementia has completely reversed when taking axona.

More disturbing is that many individuals in the study were also allowed to continue their current AD medications and their diets were not altered in anyway. This makes it impossible to know what actually caused the mild improvement in these patients.

Further, many studies on axona have been sponsored by the company that manufactures the product –a conflict of interest is a major issue. Cardiologists claim that ingesting a saturated fatty acid like caprylic acid, on a daily basis can clog up blood vessels and induce heart attacks. The Food and Drug Administration claims that it does not know if Axona works, only that it is safe to consume and that it aims to correct a recognized nutritional deficiency.

Even though the company has made a lot of hype about Axona, none of the clinical studies has been published in reputable clinical medical journals where the work can be critiqued and analyzed. Axona does not come cheap either. A month’s supply is about $80 and requires a prescription. That is about $1000 a year.

Final Point

Axona is just another food product that is being promoted to treat AD. In reality, it is still too early to develop axona mania yet. Finally remember, the field of medical foods and health supplements is not innocuous especially when one looks back at recent data on weight loss products. Moreover, it looks like Axona is no different- a lot of false promises and disappointments is what most people will get. Until more is acknowledged about this medical food, Alzheimer’s Association does not advocate use of Axona for treatment of AD.

http://www.alzheimersweekly.com/Treatment/introducing-axona-a425.html
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Can Axona help prevent Alzheimer’s Dementia? Part 1

Axona is a relatively new medical food product that is heavily touted to improve cognition and memory in patients diagnosed with mild to moderate Alzheimer’s Dementia (AD). Axona is sold as a dietary food product but requires a physician’s prescription. Axona is manufactured by the pharmaceutical company Accera. Research done in Accera laboratories has shown that treatment of metabolic deficiencies may help decrease devastating effects of AD.

In a few small-randomized studies, axona did show mild improvement in patients with dementia. The manufacturers of axona claim that that this health supplement provides an alternative source of energy to the brain cells. By providing energy to the brain, axona helps protect nerves against injury.

So does axona work?

In normal individuals, glucose is a primary source of energy for the brain. In patients with Alzheimer’s disease, there is a marked decrease in ability of brain cells to utilize glucose. The hypothesis is that when brain cells fail to use up glucose, this results in impaired memory and cognition. These metabolic defects are said to occur at least a decade earlier before symptoms of Alzheimer’s are evident.

Axona when ingested is converted by the liver into ketone bodies that provide an efficient alternative fuel for brain cells. Ketone bodies do occur naturally in our body during extended periods of fasting. There is some laboratory evidence that ketone bodies protect nerve cells. The key ingredient in Axona is a saturated fat called caprylic acid. The liver converts a portion of it into ketones, regardless of whatever nutrition the individual consumes.

At present axona has been specially formulated as a medical food for clinical management of mild to moderate AD. Axona is available as a powder and taken once a day. The company claims that there are no adverse effects of axona. The few reported side effects of axona include nausea, diarrhea, and bloating.

Axona is only available with a prescription from a physician.

Does High cholesterol increase the risk of dementia? Part 1

For decades, it has been known that high cholesterol levels are not good for the heart. High cholesterol levels have been associated with high blood pressure, increased risk of heart attacks, strokes and generalized narrowing of blood vessels. Now there is a study that shows that moderately elevated levels of cholesterol in middle-aged adults may be an increased risk factor for developing Alzheimer’s disease and other dementias.

Researchers recently published data on 9,800 individuals who were followed for more than 4 decades for development of dementia. It was observed that individuals who had high or even moderately elevated levels of cholesterol in their mid 40s had a significantly increased risk of developing Alzheimer’s disease later in life.

In the past, scientists have always tended to think of the brain and heart as two distinct organs that are affected by different pathology. However, we are now learning that what is good for the heart is also good for the brain. This concept is now being applied by physicians in recommending changes in life style in middle age to help prevent onset of dementia.

The one minor negative of the study was that researchers did not distinguish between the HDL (good) and LDL (bad) cholesterol, chiefly because the significance of these different subtypes of cholesterol was not well understood forty years ago. At present, the current guidelines mention that total cholesterol of 240 or higher is considered high, and a cholesterol of 200 to 239 is considered borderline high. Cholesterol levels less than 140-160 are being recommended.....

Aroma Oil Therapy and Dementia: Part 1

The treatment of dementia is not satisfactory and many caregivers/patients have been opting for non-conventional therapy. One such alternative therapy that has been hyped up to delay or prevent dementia is aroma oil therapy. Aroma oil therapy has been widely used to treat a number of medical ailments including insomnia, depression, anxiety and pain. Aroma oil therapy essentially involves use of pure essential oils from various fragrant plants like peppermint, sweet marjoram, and rose. The apparent minimal side effects of aromatherapy has been of magnetic attraction to alternative health care practitioners and patients.

Many herbal and health food stores advertise aromatic oils as first choice therapy in order to reduce symptoms of dementia and disturbed behavior. Anecdotal reports indicate that aromatic oils can also promote sleep and stimulate motivational behavior. It is for these reasons that many patients have increasingly turned to aromatic oils rather than pharmacological therapies.

At present, thousands of individuals use aromatic oils for personal health care. These products are readily available, do not require a prescription, and are relatively inexpensive. The question is. “do aromatic oils help treatment of dementia?”

The number of randomized studies looking at the benefits of aromatic products are small and solid data are difficult to come by. Recently Cochrane reviews looked at data from one small study where aromatic oil therapy was used for the treatment of agitation and other neuropsychiatric symptoms in individuals with dementia.

Can Centrally Acting anti hypertensive medications reduce Dementia? Part 1

Angiotensin-converting enzyme (ACE) inhibitors are important for control of blood pressure and have made a profound impact on patients with diabetes and congestive heart failure. The ACE inhibitors, which act outside the brain, have had minimal impact on dementia of any cause. However, there is now evidence indicating that ACE Inhibitors which act inside the brain, may have the ability to reduce cognitive decline.

Recent observational data from the Cardiovascular Health Study revealed that that centrally active ACE inhibitors did diminish cognitive decline by 65% per year of exposure, an effect that is likely related to the drug’s ability to cross the blood-brain barrier.

The study included 414 subjects who had been administered ACE inhibitors and 640 who had taken other antihypertensive medications. The researchers found no connection between exposure to all ACE inhibitors and risk for dementia, difference in cognitive-function scores, or odds of disability.

However, further analysis according to type of ACE inhibitor showed an unusual benefit. The results revealed that centrally active ACE inhibitors were associated with 65% less decline in cognitive-function scores per year of exposure.

This lessening in cognitive decline is not felt to be due to better control of blood pressure but most likely related to the drug’s effects on the brain's intrinsic renin-angiotensin system, which is felt to be valuable in memory and cognition. There is some laboratory evidence showing that stimulation of the renin-angiotensin system also provokes activation of inflammatory mediators which have been implicated in causing degenerative dementias.

For patients with dementia, this may be good news. There has been a huge public demand to find an intervention that can prevent or slow cognitive decline. However, the above study has to confirmed in a randomized clinical trial to determine if the above results are in fact a true observation.

Can the Mediterranean diet prevent Alzheimer’s dementia? Part 1

Over the years, there has been a great interest in ways to delay or prevent Alzheimer’s dementia. Besides use of drugs, some researchers feel that perhaps a change in diet may help prevent the decline in cognitive impairment that occurs in old age. It is widely believed that a healthy diet may help prevent development of mild cognitive impairment (MCI) and delay onset of Alzheimer’s disease (AD).

Current estimates indicate that about 10% to 15% of individuals with MCI convert to AD each year.

One of the diets thought to have some benefit in delaying mild cognitive impairment is the Mediterranean diet. Previous clinical research revealed that conformity to a Mediterranean diet was linked to a reduced risk for AD, but its effect on developing MCI was unknown.

The recent study from Washington Heights Inwood Columbia Aging Project (WHICAP) looked at the benefits of adherence to a Mediterranean diet and development of mild cognitive impairment over several years.

To explore whether cognitively normal individuals whose food intake was more representative of a Mediterranean diet were less likely to develop MCI, the researchers examined data from 1393 cognitively normal individuals and 484 individuals with MCI who were participants in the WHICAP multiethnic community study in New York. The majority of individuals studied were in the 7/8th decade of life. Study participants were given a score of 0 to 9 based on their faithfulness to a Mediterranean diet, where 9 indicated greatest adherence to this diet.

Strong adherence to a Mediterranean diet was characterized by a high intake of fish, fruit, vegetables, legumes, cereals, and unsaturated fat; a low intake of dairy products and meat; and a moderate intake of alcohol/wine.

Memantine: another expensive drug for Alzheimer’s Dementia!

There are millions of elderly individuals who have some degree of dementia. With the aging population, these numbers are going to increase a lot more in the next 2 decades. Alzheimer’s disease (AD) can create havoc in the life of the affected individual and all those who surround him/her. Despite decades of research, we still do not know what causes AD, how to prevent or treat it. The few drugs that have been developed only help relieve symptoms of AD. One of the latest drug hyped up as a miracle for patients with AD is memantine (Namenda).

Memantine has been around for decades but only recently has it been approved for treatment of dementia. Unlike Aricept, Namenda targets a different chemical in the brain- glutamate. In the laboratory, Glutamate has been shown to help improve learning and mental cognition.

Memantine works on certain areas of brain and has been shown to alter levels of a several neurotransmitters, including glutamate. The company that makes Memantine claims that the drug can help individuals who have AD.

Can thiamine help reverse or delay Alzheimer’s dementia?

Alzheimer’s is a devastating disorder that gradually results in memory impairment, disorganized thoughts, and poor reasoning. Over time, these cognitive impairments become so severe that there is a gradual decline in the individual’s usual level of functioning. Although all individuals have some degree of memory loss as part of aging, these cognitive changes generally do not interfere with level of function. In Alzheimer’s, the memory loss is much faster and associated with severe impairment in cognition. The disease progresses relentlessly and most individuals become incapable of independently looking after themselves. During the later stages of the disorder, depression, paranoia and delusions often accompany the illness and usually persists for long periods.

Today we have no cure for Alzheimer’s disease, but there are a few treatments available to alleviate some symptoms that are causing suffering.

The management of alzheimer's consists of use of medications and non-medications based treatments. The two different class of medications that have been approved by the FDA for treating Alzheimer’s include choline esterase inhibitors like Tacrine (Aricept) and partial glutamate antagonists. However, both class of drugs only work during early dementia and do not slow rate of progression of Alzheimer’s disease. Recently, there has been a surge in alternative care for patients with Alzheimer’s dementia.