[Homocysteine and dementia]

[Geriatric psychiatric home counseling for people with dementia and anosognosia : Results of a model project]

BACKGROUND

Lack of awareness of an illness (anosognosia) is a common symptom in dementia and has a significant impact on the course of the disease. It is associated with dysfunctional interaction with caregivers. Due to unawareness patients are not able to accept diagnostic procedures or medical treatment and refuse any kind of support. Thus, they are not integrated into psychosocial networks and medical support. This has a significant impact on patient-centered care in a domestic environment. In this article a model project with home visits to patients with dementia and anosognosia is described.

METHOD

A total of 55 home visits were carried out. The aim of this project was the integration into the existing healthcare services in order to safeguard the domestic environment. These visits focused on advice and information for the patients and their caregivers initiating the visits. Sociodemographic data of the patient cohort and the satisfaction of the caregiving relatives and general practitioners are presented.

RESULTS

Subjects with dementia were found to be in advanced stages of the disease, caring situations were complex and required assistance. Caregivers showed a substantial burden in accordance with previous reports.

CONCLUSION

New strategies are required to cope with anosognosia in patients with dementia and their caregivers. Even single home visits seem to be sufficient to initiate support for subjects with dementia and their relatives.

Subjektive Wahrnehmung und Bewältigung der Demenz im Frühstadium – SUWADEM

The study SUWADEM has completed the long overdue transition from objective to subjective research in the field of dementia in Germany. The perception and coping processes are reconstructed on the basis of 25 interviews with people with dementia (Pwids) and their family members. Data collection and analysis were conducted on principle of a qualitative research method, the "Grounded Theory". The subjective experience of dementia was presented in a biopsycho-social perspective. On the basis of the identified subjective ageing and disease theories, Pwids evaluate their perceived cognitive and functional deficits. According to the evaluation outcome the emotional distress varies. The lack of insight into the disease (anosognosia) in the early stage is mainly due to psychological (e.g. internalised stereotypes concerning old age) and social factors (e.g. undifferentiated subjective disease theories of person in authority). Within the framework of the disease coping process, anosognosia is a function of different forms of self-protection: (1) The regulation of emotions and the stabilisation of the sense of self-worth, (2) resistance to stigmatisation, (3) defence of one's own autonomy. The results indicate the importance of public relations work, which is intended to raise public awareness of the early stages of dementia. In addition Pwids have to be active partners in dementia research and in the development of support structures. Finally the development and evaluation of person-centered single- and group-interventions is absolutely necessary.

A role for supplements in optimizing health: the metabolic tune-up

An optimum intake of micronutrients and metabolites, which varies with age and genetic constitution, would tune up metabolism and give a marked increase in health, particularly for the poor, young, obese, and elderly, at little cost. (1) DNA damage. Deficiency of vitamins B-12, folic acid, B-6, C or E, or iron or zinc appears to mimic radiation in damaging DNA by causing single- and double-strand breaks, oxidative lesions or both. Half of the population may be deficient in at least one of these micronutrients. (2) The Km concept. Approximately 50 different human genetic diseases that are due to a poorer binding affinity (Km) of the mutant enzyme for its coenzyme can be remedied by feeding high-dose B vitamins, which raise levels of the corresponding coenzyme. Many polymorphisms also result in a lowered affinity of enzyme for coenzyme. (3) Mitochondrial oxidative decay. This decay, which is a major contributor to aging, can be ameliorated by feeding old rats the normal mitochondrial metabolites acetyl carnitine and lipoic acid at high levels. Many common micronutrient deficiencies, such as iron or biotin, cause mitochondrial decay with oxidant leakage leading to accelerated aging and neural decay.