Perhaps Think Before You Eat?

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Diets designed to boost brain health, targeted largely at older adults, are a new, noteworthy development in the field of nutrition.

The latest version is the Canadian Brain Health Food Guide, created by scientists in Toronto. Another, the MIND diet, comes from experts at Rush University Medical Center in Chicago and Harvard T.H. Chan School of Public Health.

Both diets draw from a growing body of research suggesting that certain nutrients — mostly found in plant-based foods, whole grains, beans, nuts, vegetable oils and fish — help protect cells in the brain while fighting harmful inflammation and oxidation.

Both have yielded preliminary, promising results in observational studies. The Canadian version — similar to the Mediterranean diet but adapted to Western eating habits — is associated with a 36 percent reduction in the risk of developing Alzheimer’s disease. The MIND diet — a hybrid of the Mediterranean diet and the DASH diet (Dietary Approaches to Stop Hypertension) — lowered the risk of Alzheimer’s by 53 percent.

Researchers responsible for both regimens continue to study them further in rigorous clinical trials launched this year.

Still, the diets differ in several respects, reflecting varying interpretations of research regarding nutrition’s impact on the aging brain.

A few examples: The MIND diet recommends two servings of vegetables every day; the Canadian diet recommends five. The Canadian diet suggests that fish or seafood be eaten three times a week; the MIND diet says once is enough.

The MIND diet calls for at least three servings of whole grains a day; the Canadian diet doesn’t make a specific recommendation. The Canadian diet calls for four servings of fruit each day; the MIND diet says that five half-cup portions of berries a week is all that is needed.

Carol Greenwood, a professor of nutrition at the University of Toronto and a key force behind the Canadian diet, and Martha Clare Morris, a nutritional epidemiologist at Rush University Medical Center and originator of the MIND diet, elaborate on research findings about nutrition and aging and their implications for older adults.

Nutrition And The Brain

It’s not yet well understood precisely how nutrition affects the brains of older adults. Most studies to date have been with animals or younger adults.

What is clear: A poor diet can increase the risk of developing hypertension, cardiovascular disease, obesity and diabetes, which in turn can end up compromising an individual’s cognitive function. The corollary: A good diet that reduces the risk of chronic illness is beneficial to the brain.

Also, what people eat appears to have an effect on brain cells and how they function.

“I don’t think we know enough yet to say that nutrients in themselves support neurogenesis (the growth of neurons) and synaptogenesis (the growth of neural connections),” Greenwood said. “But pathways that are needed for these processes can be supported or impaired by someone’s nutritional status.”

Essential Nutrients

“Several nutrients have been shown to have biological mechanisms related to neuropathology in the brain,” Morris said.

On that list is Vitamin E, a powerful antioxidant found in oils, nuts, seeds, whole grains and leafy green vegetables, which is associated with slower cognitive decline, a lower risk of dementia, and reduced accumulation of beta-amyloid proteins — a key culprit in Alzheimer’s disease.

“The brain is a site of great metabolic activity,” Morris said. “It uses an enormous amount of energy and in doing so generates a high level of free radical molecules, which are unstable and destructive. Vitamin E snatches up those free radicals and protects the brain from injury.”

Also on her list is vitamin B12 — found in animal products such as meat, eggs, cheese and fish — and vitamin B9 (folate), found in green leafy vegetables, grains, nuts and beans.

Because aging affects stomach acids that facilitate the absorption of B12, “everyone who gets to middle age should have a doctor check their B12 levels,” Morris said. A deficiency of this vitamin can lead to confusion and memory problems, while folate deficiency is associated with cognitive decline and an increased risk of dementia.

Omega-3 fatty acids found in fish and nut oils, especially DHA (docosahexaenoic acid), are highly concentrated in the brain, where they are incorporated in cell membranes and play a role in the transmission of signals between cells.

“A primary focus has to be maintaining healthy” blood vessels in the brain, Greenwood said. “So, heart health recommendations are similar in many ways to brain health recommendations, with this exception: The brain has higher levels of Omega-3s than any other tissue in the body, making adequate levels even more essential.”

Other studies point to calcium, zinc and vitamins A, C and D as having a positive impact on the brain, though findings are sometimes inconsistent.

Foods To Avoid

For the most part, the Canadian and MIND diets concur on foods to be avoided or limited to once-a-week servings, especially saturated fats found in pastries, sweets, butter, red meat and fried and processed foods.

As for dairy products, “there’s no evidence one way or another. If you like your yogurt, keep eating it,” Morris said. Greenwood adds a caveat: Make sure you consume low-fat dairy products as opposed to whole-fat versions.

Other Helpful Diets

Randomized clinical trials have demonstrated that both the Mediterranean diet and the DASH diet have a positive impact on various aspects of cognition, although neither was created specifically for that purpose.

“At the end of the day, our [Canadian] diet, the MIND diet, the Mediterranean diet and the DASH diet are not that different; they’re all likely to be helpful,” Greenwood said.

The Pattern Counts

Studies promoting the cognitive benefits of drinking tea or eating blueberries have recently garnered the headlines. But a focus on individual foods is misguided, both experts suggested. What matters instead are dietary patterns and how components of various foods interact to promote brain health.

The bottom line: Concentrate on eating an assortment of foods that are good for you. “As long as people are eating a healthful diet, they shouldn’t have to worry about individual nutrients,” Greenwood said.

Does Your Insurance Cover Alzheimer’s Care?

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Senior man sitting on a wheelchair with caregiverOne in eight individuals 65 and older suffers from Alzheimer’s disease –quite a sobering statistic for the growing number of baby boomers rapidly crossing that age threshold. And the costs can be an “overwhelming financial burden,” says Carol Steinberg, executive vice-president of the Alzheimer’s Foundation of America.

Private and government insurance programs may cover some costs. Here’s a primer on your options.

Medicare

Many people are shocked to discover that Medicare does not cover the long-term custodial care that Alzheimer’s patients need. Custodial care is the non-medical care associated with activities of daily living, such as bathing and dressing.

Medicare does cover limited care in a nursing facility or at home. For home care, the patient must require skilled-nursing care or physical or occupational therapy to help with the recovery from an illness or injury — not to help an Alzheimer’s patient with daily-living activities. “One of the most difficult situations is when a loved one needs personal or custodial home care, but Medicare will only cover that if there is some type of skilled-care need,” says Frederic Riccardi, director of programs and outreach for the Medicare Rights Center, an advocacy group.

At-home services in most cases can be provided for fewer than seven days each week or less than eight hours each day over a period of 21 days or less. Limited custodial care could be provided during these visits — perhaps if an Alzheimer’s patient treated by a registered nurse for a broken hip needs help bathing. Medicare pays the cost of a skilled-nursing facility, but only to provide continuing treatment following a hospital stay of at least three days. Skilled care in a facility is limited to 100 days.

While Medicare offers little by way of custodial care, it does provide diagnostic and medical treatment that Alzheimer’s patients need. The new annual wellness physical exam, which is free and part of the health care law, includes testing for cognitive impairment. “This is a critical, yet hardly known, provision,” Steinberg says. Medicare also covers visits to a geriatric assessment clinic.

Alzheimer’s patients and their families need to carefully choose a Medicare Part D prescription-drug plan or private Medicare plan. Alzheimer’s medications are generally covered under Part D, but plans vary regarding co-payments. The Alzheimer’s Association offers a guide about coverage for common Alzheimer’s drugs.

If you choose a Medicare Advantage plan, make sure your neurologist and other physicians you see often are covered as in-network providers. Otherwise, you will pay higher out-of-pocket costs or ask about Medicare supplement plans.

Long-term-care insurance

These policies provide coverage for the custodial care that Alzheimer’s patients usually need. Benefits typically trigger if the patient needs help with at least two activities of daily living or if a doctor provides evidence of cognitive impairment. Because most people with Alzheimer’s receive care in their own homes, look carefully at the policy’s home-care requirements. Typically, a patient must wait 60 or 90 days before benefits begin. But policies differ on when the clock starts ticking, which could be a big headache for caregivers. 

Some long-term care insurance policies start the 60-day waiting period on the day the doctor certifies the cognitive impairment — and benefits trigger 60 days later. But other policies count only the days a patient receives care from a qualified caregiver during the waiting period. If the caregiver visits two days a week, the policy only counts those two visits toward the 60-day waiting period — and benefits will not trigger for 30 weeks. In the meantime, the family has to pick up the tab for the caregiver.

Before you hire a caregiver, check the policy’s fine print on the type of caregiver the insurance company will cover. Some policies pay for any caregiver who is not a family member, while others only pay for licensed caregivers who work for an agency. Some families who hire an unlicensed caregiver later discover that the caregiver doe not qualify under the policy.

Do not expect a policy to pick up round-the-clock home care. Daily coverage is based on the daily benefit. A policy with a $200 daily benefit, for example, will likely cover the cost of eight to ten hours of a home health aide. If a family caregiver cannot fill in the gap, a nursing home may be a better option.

You cannot use more than your daily benefit in a day, but you can stretch your daily benefit over longer periods. Say you choose a benefit period of three years, at $200 a day. If you only use $100 a day, your coverage can last for six years. Some policies cover adult day care, which can cost a lot less than daily caregivers. “Many adult day services specialize in care for those with Alzheimer’s disease and similar disorders,” says Kathy O’Brien, senior gerontologist with the MetLife Mature Market Institute.

An alternative and more cost-effective option for long-term care insurance in today’s expensive health care environment is a short-term custodial care policy.

Medicaid

This program, whose costs are shared by federal and state governments, is the primary payer of long-term-care services for the elderly. Unlike Medicare, it provides custodial care for Alzheimer’s patients. Custodial care typically is provided in Medicaid-eligible nursing homes, but many states’ Medicaid programs now pay for home care and sometimes adult day care or care in assisted-living facilities, says O’Brien.

 

The downside: You need to be virtually impoverished to qualify. Many people end up qualifying after spending their retirement savings on care. While state laws differ, generally you cannot have more than $2,000 in countable assets, including investments. A spouse who lives at home can generally keep about $113,000. You’re allowed to keep your home, car and assets in certain kinds of trusts. (Visit www.medicaid.gov to find eligibility requirements in your state.)

To protect more of your assets, you can buy a state-approved long-term-care policy that is “partnership” eligible. The policy would allow you to qualify for Medicaid without having to spend almost all of your money first. For example, if you buy a partnership policy that covers $200,000 of care, you would pay out of pocket until you have $200,000 left and still qualify for Medicaid. Go to the National Clearinghouse for Long Term Care Information to see if your state allows these policies.