Can Bad Thoughts Bring on Dementia?

There is recent research that has shown a link between repeated patterns of repetitive negative thinking (RNT) and signs of dementia. This study suggests a link between the key signs of dementia, the buildup of proteins in the brain and cognitive decline, and RNT.

Medical News Today reported in its recent article entitled “Link between dementia and repetitive negative thinking identified” that this study was published in the journal Alzheimer’s & Dementia. The study set forth the foundation for future research to consider how the link may function, and if psychological therapies that treat RNT can inhibit Alzheimer’s and other dementias.

The CDC explains that dementia is a term that represents a variety of diseases characterized by cognitive decline, which includes trouble remembering, thinking or making decisions that adversely affect a person’s everyday life.

The most common type of dementia is Alzheimer’s disease. This is a degenerative disease, which means it worsens over time. It’s not yet known exactly what causes Alzheimer’s disease. The CDC says that there are likely several factors involved. There is currently no cure for Alzheimer’s.

Prior research has suggested that psychological factors, like depression and anxiety, may also have a connection to Alzheimer’s. This has led researchers to develop the concept of cognitive debt as a risk factor for Alzheimer’s disease, which they believe is acquired by RNT. A large part of RNT are processes of rumination — repeatedly thinking about the past — and worry, being concerned about the future.

The research examined the participants’ RNT, depression, anxiety and cognitive decline levels for up to four years. They also measured the levels of tau and amyloid proteins in the brains of 113 of the participants. Scientists think that the buildup of these structures is key to the development of Alzheimer’s.

The authors of the new research discovered that the higher a person’s RNT, the faster their cognitive decline. They also found these people were more likely to have significant deposits of tau and amyloid proteins. However, although the research found a link between depression and anxiety and cognitive decline, they did not find a connection between depression and anxiety and the buildup of tau and amyloid proteins.

According to the lead author of the study Dr. Natalie Marchant of University College, London, United Kingdom, “[d]epression and anxiety in mid-life and old age are already known to be risk factors for dementia. Here, we found that certain thinking patterns implicated in depression and anxiety could be an underlying reason why people with those disorders are more likely to develop dementia.

“Taken alongside other studies that link depression and anxiety with dementia risk, we expect that chronic negative thinking patterns over a long period of time could increase the risk of dementia. We do not think the evidence suggests that short-term setbacks would increase one’s risk of dementia.

“We hope that our findings could be used to develop strategies to lower people’s risk of dementia, by helping them to reduce their negative thinking patterns.”

The study’s authors say that it’s probable that RNT contributes to Alzheimer’s in some way, possibly elevating an individual’s stress levels. However, they couldn’t discount the possibility that early signs of Alzheimer’s could lead to RNT.

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Reference:  Medical News Today (June 11, 2020) “Link between dementia and repetitive negative thinking identified”

Elder Abuse Continues as a Billion-dollar Problem

Aging baby boomers are a giant target for scammers. A report issued last year from a federal agency, the Consumer Financial Protection Bureau highlighted the growth in banks and brokerage firms that reported suspicious activity in elderly clients’ accounts. The monthly filing of suspicious activity reports tied to elder financial exploitation increased four times from 2013 through 2017, according to a recent article from the Rome-News Tribune titled “Financial abuse steals billions from seniors each year.”

When the victim knew the other person, a family member or an acquaintance, the average loss was around $50,000. When the victim did not have a personal relationship with their scammer, the average loss was around $17,000.

What can you do to protect yourself, now and in the future, from becoming a victim? There are many ways to build a defense that will make it less likely that you or a loved one will become a victim of these scams.

First, don’t put off taking steps to protect yourself, while you are relatively young. Putting safeguards into place now can make you less vulnerable in the future. If you are diagnosed with Alzheimer’s or another form of dementia five or ten years from now, it may be too late.

Create a durable power of attorney as part of your estate plan. This is a trusted person you name as your legal representative or agent, who can manage your financial affairs if need be. While it is true that family members are often the ones who commit financial elder abuse, you’ll need to put your trust in someone. Usually this is an adult child or a relative. Make sure that the POA suits your needs and is properly notarized and witnessed. Don’t count on standard templates covering your unique needs.

Consider the guaranteed income approach to retirement planning. Figuring out how to generate a steady stream of income as you face the cognitive declines that occur in later years might be a challenge. Planning for this in advance will be better.

Social Security is one of the most valuable sources of guaranteed income. If you will receive a pension, try not to do a lump sum payout with the intent to invest the money on your own. That lump sum makes you a rich target for scammers.

Consider rolling over 401(k) accounts into Roth accounts, or simply into one account. If you have one or more workplace retirement plans, consolidating them will make it easier for you or your representative to manage investments and required minimum distributions.

Make sure that you have an estate plan in place, or that your estate plan is current. Over time, families grow and change, financial situations change and the intentions you had ten, twenty or even thirty years ago, may not be the same as they are today. An experienced estate planning attorney can ensure that your wishes today are followed, through the use of a will, trust and other estate planning strategies.

Resource: Rome News-Tribune (April 27, 2020) “Financial abuse steals billions from seniors each year.”

Medications That Can Raise Your Risk of Dementia

A recent study has found there is an entire classification of medications that can raise your risk of dementia. Doctors prescribe these drugs frequently for seniors. The patients do not have to take the medications long-term to be significantly more likely to develop dementia.

The research focused on nearly 300,000 people, age 55 and older, over a 12-year period. The scientists found an association between the drugs and dementia risk. If, indeed, these medicines cause dementia, the statistics indicate these drugs could be responsible for about 10 percent of the cases of dementia. Since so many older adults take the types of medications now associated with a higher risk of dementia, this information could impact the lives of millions of people and their loved ones.

Types of Drugs That Increase Your Risk of Dementia

The category of medications found to have an association with a higher likelihood of dementia is anticholinergic drugs. The medical community has known about a link between these substances and memory issues or confusion for quite some time. The new study took the matter a step further to exploring dementia risk.

The anticholinergic drugs with the strongest association with dementia include:

  • Antidepressants, for example, amitriptyline and paroxetine
  • Treatments for overactive bladder, using bladder antimuscarinics like tolterodine and oxybutynin
  • Anti-seizure medications for epilepsy, like carbamazepine and oxcarbazepine
  • Anti-psychotic drugs, such as olanzapine and chlorpromazine

Doctors prescribe anticholinergic medications to treat a wide range of maladies, including motion sickness, vertigo and the conditions named above.

The Dosage Required to Affect Your Dementia Risk

According to the study, you would only have to take one pill a day for three years to have a higher risk of dementia. The drugs studied can increase the likelihood of dementia by almost 50 percent at that dosage.

Drugs That Do Not Increase Your Risk of Dementia

Some types of anticholinergic medications do not appear to increase the risk of dementia. For example, the researchers found no association between dementia risk and these anticholinergics:

  • Anti-arrhythmic drugs
  • Antimuscarinic bronchodilators
  • Skeletal muscle relaxants
  • Antihistamines
  • Gastrointestinal antispasmodics

The study did not give an explanation for why some classifications of anticholinergic drugs have an association with a higher likelihood of dementia and other types do not. In response to the article that published the study results, some medical experts call for research to determine if a patient can reverse the increased risk factor by stopping the drugs.

What You Should Do If You Take Anticholinergic Drugs

There is a wide variety of increased dementia risk, depending on which type of anticholinergic medication you take. Medical experts warn you should not stop taking your medicine without talking with your doctor first. The type of drug you take might have a low association with dementia.

It can also be harmful to stop taking a medication suddenly. Drugs that prevent seizures, depression, or psychosis should never get discontinued, without medical intervention and monitoring. Work with your doctor to evaluate the risk of the specific medicine you take and consider switching to another drug that could treat your condition without as much chance of developing dementia.

Your state might have different regulations than the general law of this article. You should talk with an elder law attorney in your area.

References:

CNN. “Commonly prescribed drugs tied to nearly 50% higher dementia risk in older adults, study says.” (accessed December 19, 2019) https://www.cnn.com/2019/06/24/health/dementia-risk-drug-study/index.html

How Did Alzheimer’s Impact the Estate Planning of These Famous People?

Forbes’ recent article, “Top 7 Celebrity Estates Impacted By Alzheimer’s Disease” looks at seven celebrity estates that were affected by Alzheimer’s disease.

  1. Rosa Parks. The civil rights icon died at 92 in 2005. She was suffering from Alzheimer’s disease. Legal battles over her estate continue to this day. Her estate plan left her assets to a charitable institution she created. However, her nieces and nephews challenged the validity of her will and trust, due to her mental deficiencies and allegations of undue influence. That claim was settled, but there have been fights over broken deals and leaked secrets, claimed mismanagement of her estate and assets, allegations of bribery and corruption and a battle over Rosa’s missing coat that she wore at the time of her famous arrest at the Alabama bus stop in 1955.
  2. Gene Wilder. Wilder’s widow–his fourth wife, Karen–and his adopted daughter didn’t fight over Gene’s estate after he died, which shows good estate planning. Wilder makes the list because of how his widow used her husband’s struggle—which she kept private while he was alive—to bring attention to the terrible disease, including permitting his Willy Wonka character to be used in a campaign to raise awareness.
  3. Aaron Spelling. The Hollywood producer left behind a reported fortune worth $500 million. His death certificate listed Alzheimer’s disease as a contributing factor. Spelling changed his estate plan just two months before he died, reducing the share to his daughter, actress Tori, and his son, Randy, to $800,000 each.
  4. Etta James. Legendary blues singer Etta James passed away in 2012, at 73. Her family said she had been struggling with Alzheimer’s disease for several years, and her illness ignited an ugly court battle between her husband of more than 40 years and her son from a prior relationship, over the right to make her medical and financial decisions, including control of her $1 million account. Her husband, Artis Mills, alleged that the power of attorney she signed appointing her son as decision-maker was invalid, because she was incompetent when she signed it. Mills sued for control of the money to pay for Etta’s care. After some litigation, Etta’s leukemia was determined to be fatal, which led to a settlement. Mills was granted conservatorship and permitted to control sums up to $350,000 to pay for Etta’s care for the last few months of her life.
  5. Peter Falk. The Lieutenant Columbo actor died at 83 in 2011, after living with Alzheimer’s disease for years. His wife Shera and his adopted daughter Catherine fought in court for conservatorship to make his decisions. Shera argued that she had power of attorney and could already legally make Peter’s decisions for him, which included banning daughter Catherine from visits. The judge granted Shera conservatorship, but ordered a visitation schedule for Catherine. However, a doctor, who testified at the hearing, said that Falk’s memory was so bad that he probably wouldn’t even remember the visits.
  6. Tom Benson. The billionaire owner of the New Orleans Saints and Pelicans was the subject of a lengthy and bitter court battle over control of his professional sports franchises, and hundreds of millions of dollars of other assets. Prior trusts, that he and his late wife established, left the sports franchises and other business interests to his daughter and two grandchildren. One of granddaughters operated the Saints as lead owner, until she was fired by her grandfather. Tom decided to take the controlling stock of the teams out of the trust and substitute other assets in their place, taking over control of the teams. However, his daughter and grandchildren fought the move. A 2015 court ruling declared Benson to be competent, despite allegations he suffered from Alzheimer’s disease. Benson then changed his will and trust and left everything to his third wife, Gayle. They all settled the dispute in 2017, leaving other assets to the daughter and grandchildren—but ultimately leaving Gayle in control of the Saints and Pelicans, after Benson’s death in 2018 at age 90.
  7. Glen Campbell. Campbell’s 2007 estate plan left out three of his adult children. They sued to challenge their disinheritance after he died. They dropped the case in 2018, without receiving a settlement. The fact that Campbell’s final will was drafted several years prior to his Alzheimer’s diagnosis was a critical factor in the outcome of the lawsuit.

The estate planning of these celebrities show the importance of proper estate planning, before it is too late. Wills and trusts that are created or changed after someone is diagnosed with Alzheimer’s disease, dementia, or similar conditions are more apt to be challenged in court.

Click here If you are interested in learning more about estate planning, elder law, or long-term care planning.

Reference: Forbes (November 25, 2019) “Top 7 Celebrity Estates Impacted By Alzheimer’s Disease”

Preparing for Alzheimer’s

Once there has been a diagnosis of dementia, there are a number of issues that families need to address, including legal issues. The best way to approach this task, says being patient in the article “Alzheimer’s and the Law” is to meet with an estate planning attorney who can guide the family in planning for the future, and creating the needed documents.

The conversation will start with who should be named to two different kinds of power of attorney. One is for the durable power of attorney, which will give the named person the ability to manage any business decisions, sign contracts and deal with insurance companies. This document will need to be inclusive, so the agent can act for the person who is going to be incapacitated.

Next, there will need to be a healthcare power of attorney. It should be complemented by a living will, which states what kind of lifesaving measures you would want, if you were to be declared terminally ill. The healthcare power of attorney also allows a person to be named to make medical decisions, if the person with dementia can no longer make good decisions on their own behalf.

As long as the doctor has not yet declared the person incapacitated, they can sign the power of attorney for financial and health care. If the person has been declared incapacitated, then the family will need to go to court for a guardianship proceeding, so the court can declare who will be in charge of the person with dementia.

Some families prefer to have one person in charge of the loved one’s financial affairs and a second person to be their healthcare power of attorney. If there is a family member who is good with money and business, that person will do a better job than someone whose heart is in the right place but doesn’t manage money well. A nervous or easily excitable family member may also not be the best choice for healthcare power of attorney, especially if important decisions need to be made in a crisis situation.

Make sure that the people who are being considered for these tasks live near enough, so they can be available when needed. A child who lives on the other side of the country may want to be the decision maker, but if they are too far away, it will create more problems than it solves.

Before naming anyone to the power of attorney roles, speak with them about the situation, and be clear about what they will be expected to do. Clarify the difference between the two roles, and that of the executor. The executor is the person who is in charge of the person’s estate after they pass. They do not have an active role, while the person is living.

People generally don’t like to think about times when they may not enjoy good health, but this is a situation where waiting to address the issue can become extremely costly. A skilled estate planning attorney who works with families with dementia will understand the situation. They can be a valuable resource of information about other related services that will become needed over time.

Reference: being patient (August 22, 2019) “Alzheimer’s and the Law”