...542 學術 阿茲海默失智症的食療科學證據 文/孫 瑜 邱銘章* 李明濱** 恩主公醫院神經內科 台大醫院神經內科* 台灣失智症協會理事長** 背 景 阿茲海默失智症為一逐漸腦部退化以致於喪失智 能的疾病，包括喪失智力與生活能力，年紀愈大，愈 易得病，這是現在人口結構逐漸老化的社會，必須面 對的重要議題。長久以來，就有不少研究在探討飲食 與失智症的相關性，包括食物種類與得病的相關性， 及以飲食型態來預防或延緩疾病惡化。這些飲食的研 究中，有不少建議攝取富含維他命C、E及胡蘿蔔素等 抗氧化食物來預防或改善失智症的惡化，另外維他命 B群、葉酸，不飽合脂肪酸、魚類、酒類等，都曾被 報導過可降低阿茲海默失智症的風險。不過上述這些 研究的結論常常不一致。另外，臺灣很流行的保健食 品如紅麴及銀杏也被奉為預防失智症的聖品，還有現 在很熱門的地中海飲食，這些食物對阿茲海默失智症 的預防及治療效果的科學證據仍須進一步探討。本篇 研究擬以實證醫學的方法探討飲食對失智症的防治效 果，進而希望為高齡族群提供飲食的建議。 方 法 分兩階段進行。第一階段：先以一般性回顧的方 法搜尋及整理阿茲海默失智症的完整且有臨床試驗的 飲食研究。從Pub Med中搜尋以關鍵字「nutrition」或 「diet」連結 「Alzheimer's dementia」或「Alzheimer's disease」搜尋相關的文章。並設定為回顧(review)性 文章，語言為英文或中文，起始年代不設限，搜尋至 2009年。總共找到73篇文章，其中再進一步將動物 實驗、基礎實驗及病理研究去除。如此一來，剩下33 篇，其中館際合作能找到24篇，再從中去挑選回顧性 研究中，所有收集納入分析比較的臨床試驗(含世代研 究及病例對照研究)最完整的文章，加以整理。另外也 加入我們自己團隊的研究。第二階段：是分別針對國 內常被報導的保健產品、食品及飲食型態，如紅麴、 銀杏、地中海飲食及咖哩等，用於阿茲海默失智症的 所有研究，探討其目前臨床科學性的結論為何。 結 果 以下分別就不同的飲食因素與阿茲海默失智症相 關性加以探討： 1.抗氧化飲食 阿茲海默失智症患者腦中的β類澱粉蛋白，會在 腦中形成過氧化反應，進一步造成神經元的損傷(1)，這 些腦中的氧化反應是阿茲海默失智症的是原因還是結 果，並不是很清楚，不過已有不少研究在探討以食物 中的抗氧化物質，來影響阿茲海默失智症的病程 (2) 。 常被研究的抗氧化物包括維他命E、維他命C及胡蘿蔔 素。有些研究發現阿茲海默失智症患者血中的這些抗 氧化物質濃度偏低。食物中維他命E的來源很廣，包 含蔬果、肉(牛羊豬)、魚與乳酪 (3)。維他命C的來源則 多為蔬果及胡蘿蔔 (3)。β胡蘿蔔素來源則為青菜(特別 是青花椰菜)、紅蘿蔔、水果如木瓜、蕃茄及葡萄柚等 (3) ，觀察幾個較大型的前瞻性臨床研究，其營養的介入 可分為攝取維他命及攝取富含這些維他命的飲食(多是 問卷及電訪的方式)，整理如表1 (4)。吾人可發現這些研 究的結論並不一致。不過可看出以下三點趨勢：1.以富 含維他命E、C的食物供給來減少失智症的發生，結果 是有效的多於無效的研究。2.富含維他命E、C食物對 預防失智症的證據，比以維他命E、C藥物還多(食物優 於藥物)。3.在失智症防治上，維他命E的飲食比維他命 C的證據還強。 2.維他命B群，葉酸與失智症 維他命B12或葉酸缺乏會造成神經細胞的損傷及 中樞神經病變(5)。也會造成智力的退化，這也是失智症...
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...day care centers offer this much needed break or solo time needed to complete such items on one’s to-do list (About Adult Day Service). One might feel guilty when deciding whether they should leave such elderly persons in the care of another but consider the fact that if you were to run yourself ragged, what help would you be to a person with dementia or in need of constant assistance? A nice break may make one feel recharged and not so helpless when the day’s work has one so exhausted (Adult Day Care). Now consider yourself being the main family income supplier and one might panic at the thought of losing any kind of job stability. Adult day care centers can establish a daily and/or weekly service to help one try to balance the role of caregiving and job duties. Evening and weekend hours, transportation and meals are often provided with varying services included. For those elderly with imparities such as Alzheimer’s and dementia, these adult day care centers offer them a wonderful opportunity to be social and participate in activities such as exercise, art and musically centered programs while in turn promoting their well-being. References About Adult Day Services| NADSA: adult day care services. (n.d.). Retrieved from http://nadsa.org/learn-more/about-adult-day-services/ Adult Day Care. (n.d.). Retrieved from http://www.eldercare.gov/Eldercare.NET/Public/Resources/Factsheets/Adult_Day_Care.aspx#Benefit Adult Day Care Services: Finding the Best Center for Your Needs....
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...Article: The Mind Recovery Act - Why Obama's "War on Alzheimer's" may pay off This article struck my fancy because I have worked in the healthcare field, specifically with alzheimer's patients. I have also attended a lecture regarding studies done on Alzheimer's disease. This disease and potential treatments fascinate me and I am keeping my fingers crossed that a cure will be found by Obama's date of 2025. The author says, "Government declarations of war on drugs or disease often end in losing battles. That is why some neuroscientists have greeted the Obama administration’s goal of preventing or treating Alzheimer’s by 2025 with skepticism." (1) While I understand the author's concern about declarations leading to losing battles, I also believe that speaking out against drugs and disease can lead to positive change. Last semester in my Biostatistics class, I had the opportunity to attend a lecture from a member of the Cache County Study on Memory Health and Aging. It is a collaborative group of studies with researchers at Utah State University, Duke University Medical Center and The John Hopkins University. This study is conducted in Cache County, Utah and is designed to examine genetic and environmental factors associated with risk for Alzheimer's disease. This study has been going for longer than 16 years and has enrolled over 5000 residents of the county. The reason the study is conducted here is because Cache County elderly have longer life expectancy than...
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...Educational Gerontology, 40: 655–665, 2014 Copyright # Taylor & Francis Group, LLC ISSN: 0360-1277 print / 1521-0472 online DOI: 10.1080/03601277.2013.863573 Gaps in Alzheimer’s Knowledge Among College Students Elaine M. Eshbaugh School of Applied Human Sciences, University of Northern Iowa, Cedar Falls, Iowa, USA Despite the prevalence of the disease, it appears that there may be a need for increased education for formal and family caregivers of those with Alzheimer’s disease and related dementias. Today’s college students will be asked to fill both of these roles in the future. This study examined the level of knowledge of Alzheimer’s disease among college students. Two-hundred college students at a mid-sized midwestern university completed an online survey that included the Alzheimer’s Disease Knowledge Scale (Carpenter et al., 2009). Although most participants knew that people with Alzheimer’s remember things from the distant past better than more recent events, many college students were unfamiliar with risk factors and average life expectancy. Implications and recommendations for educational programs and curriculum are discussed. Alzheimer’s disease and related dementias are significant health concerns affecting our older adult population (Sullivan & Muscat, 2007). As our population continues to age and our demography shifts to higher proportions of elders, the number of individuals diagnosed with Alzheimer’s and dementia continues to increase. Although...
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...prepared for looking after patients are under pressure because of their increasing needs. Georges does not seem to mind this responsibility of taking care of her initially, but Anne’s condition deteriorates fast. She experiences profound right sided weakness and is bound to the wheelchair. Georges struggles to lift her from the wheelchair and make her sit on a chair or go the bathroom. Increased stress in his behaviour is noted when he is unable to sleep at night and begins smoking again. He also wakes up wailing after a nightmare. Despite his obvious incapability to cope with her illness, Georges does not hospitalise Anne, respecting her wishes and dismisses a hired nurse, since she is not compassionate and caring. Research has shown that caregiving is extremely taxing and exhausting. The caregiver faces the...
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...A BUSINESS PLAN DESCRIBING EVIDENCE BASED INTERVENTION TO IMPROVE OUTCOME IN THE LATE STAGE OF ALHEIMEZER DISEASE Name: Institution: Introduction Dementia is perceived as a clinical condition that is not completely taken as the outcome of delirium which comprises of the universal cognitive drop in the memory along with other regions of cognition that is affected with effects on day-to-day operations and meets the DSM-IV-TR criterion. The most general type of dementia is described by a drop in the cortical features of cognition and a subsequent characteristic time course of continuing onset as well as development. On the other hand, Alzheimer disease is described as a certain kind of degenerative brain illness characterized by senile plaques, progressive neuronal loss, neuritic tangles and the possible effects of AD. Consequently, this business proposal will highlight on the mission statement along with the objective of my business plan concerning the evidence-based intervention in the late stage of Alzheimer. Mission statement Our mission statement will be to provide evidence-based intervention to improve outcome in the late stage of Alzheimer. This may, in turn, have an impact on the well-being of the people providing the care. Since this is a position statement concerning the evidence-based intervention to improve outcome in the late stage...
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...Mr. Speed Alzheimer’s Case Study Erica Boozer HCS/245 January 7, 2015 Lisa Spencer Mr. Speed Alzheimer’s Case Study My name is Dr. Boozer. This is the case study of Mr. Speed and the condition of his Alzheimer disease. This memo will cover Alzheimer disease as a whole and resources of where more information about the disease can be found. This memo will also discuss any cultural issues that Mr. Speed may face having the disease and the impact Alzheimer’s has on society and its resources. Alzheimer’s is a disease that effects the central nervous system. According the livestrong.com, the loss of functioning brain tissue that occurs with Alzheimer disease initially causes problems with memory and learning. Personality, intellectual function and mood are greatly affected as the disease progresses. As Mr. Speed get in the later stages of the disease, it should be expected that he will lose his sense of self and present things that are going on around him (livestrong.com, 2015). In the early stages of this disease, Mr. Speed may not need any assistance with day to day activities. However as it progresses to where he experiences memory loss or trouble doing simple task such as paying bills, he may require some type of supervision (alz.org, 2015). More information such as symptoms, other systems of the body that Alzheimer’s may effect or what to expect in the different stages of this disease can be found on livestrong.com and alz.org. Alzheimer effects all races and ethnicities...
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...A BUSINESS PLAN DESCRIBING EVIDENCE BASED INTERVENTION TO IMPROVE THE OUTCOME IN THE LATE STAGE OF ALZHEIMER DISEASE Name: Institution: A business plan describing evidence-based intervention to improve outcome in the late stage of Alzheimer disease Executive summary According to the “British Medical Journal (BMJ)” on the subject “Care plans for individuals with Alzheimer disease: Intuitively a good idea but hard to prove they are effective in practice.” It is seen that teaching based intervention for Alzheimer care are suggested by large professional organizations although it is not evident on who should undertake these models to the patients. Care plans replicas along with the guidelines usually do have the stated objectives of delaying an illness development and functional beg off (Schneider, 2016). Alzheimer is illustrated by momentous impairments in several cognitive areas, functioning as well as the behavioral burden. Premature revealing, as well as management, can avert overuse of expensive healthcare resources and permit the affected people and caregivers the time to prepare for the prospect financial, medical along with the emotional confronts. This planning proposal offers the right measures concerning the evidence-based intervention to improve outcome in the late stage of Alzheimer disease. Among the cited evidence-based intervention that the business proposes to employ in combating...
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