Many colon cancer patients aren’t getting the screenings recommended after surgery to make sure the disease hasn’t returned, new research shows.

Only about 40 percent of the 4,426 older patients in the study got all the doctor visits, blood tests and the colonoscopy advised in the three years after cancer surgery, according to the results released Monday by the journal Cancer.

While nearly all made the doctor visits and almost three-quarters got a colonoscopy, many didn’t get the blood tests that can signal a return of colon cancer, according to the researchers at University Hospitals Case Medical Center in Cleveland, Ohio.

Whether doctors didn’t offer the tests or patients failed to get them isn’t known, said Dr. Gregory Cooper, who led the study. He said perhaps the follow-up care was being provided by doctors who aren’t specialists and who aren’t familiar with the guidelines.

“I would probably put most of the blame on the providers,” said Cooper, a gastroenterologist at the hospital.

Colorectal cancer will be diagnosed in an estimated 149,000 Americans this year. Survival after five years varies from 90 percent for cancer that hasn’t spread to 10 percent for advanced cases.

Cooper and his colleagues used a federal database of cancer cases and Medicare records for patients to see whether the guidelines were being followed. They focused on those 66 and older with less advanced cancer who had surgery that could cure them.

Patients were tracked for three years, beginning six months after surgery. When the study began in 2000, the minimum guidelines called for at least two doctor visits a year, twice yearly blood tests for two years and a colonoscopy within three years. Cooper said a colonoscopy is now recommended in the first year.

Overall, 60 percent of the patients didn’t meet the guidelines. Of those who did, more than half actually got advanced medical scans such as CT scans and PET scans that are not recommended for routine screening. The scans could have been done because of signs or symptoms of a recurrence but the researchers said they suspect they were done for routine follow-up.

There was less screening among older age groups, African-Americans and those with other health problems.

“Quite honestly, I’m sorry to say, I’m not surprised about the findings,” said Dr. Len Lichtenfeld, deputy chief medical officer for the American Cancer Society, which funded the study. Despite advanced medical technology, “our ability to deliver the recommended care to patients has left something to be desired.”

With the information resources available today, he said patients can take an active role in their follow-up care and make sure that they are getting the screenings they need.

CANBERRA (Reuters) - Just one can of the popular stimulant energy drink Red Bull can increase the risk of heart attack or stroke, even in young people, Australian medical researchers said on Friday.

The caffeine-loaded beverage, popular with university students and adrenaline sport fans to give them “wings”, caused the blood to become sticky, a pre-cursor to cardiovascular problems such as stroke.

“One hour after they drank Red Bull, (their blood systems) were no longer normal. They were abnormal like we would expect in a patient with cardiovascular disease,” Scott Willoughby, lead researcher from the Cardiovascular Research Centre at the Royal Adelaide Hospital, told the Australian newspaper.

Red Bull Australia spokeswoman Linda Rychter said the report would be assessed by the company’s head office in Austria.

“The study does not show effects which would go beyond that of drinking a cup of coffee. Therefore, the reported results were to be expected and lie within the normal physiological range,” Rychter told Reuters.

Willoughby and his team tested the cardiovascular systems of 30 young adults one hour before and one hour after consuming one 250ml can of sugar-free Red Bull.

The results showed “normal people develop symptoms normally associated with cardiovascular disease” after consuming the drink, created in the 1980s by Austrian entrepreneur Dietrich Mateschitz based on a similar Thai energy drink.

Red Bull is banned in Norway, Uruguay and Denmark because of health risks listed on its cans, but the company last year sold 3.5 billion cans in 143 countries. One can contains 80 mg of caffeine, around the same as a normal cup of brewed coffee.

Rychter said Red Bull could only have such global sales because health authorities across the world had concluded the drink was safe to consume.

But Willoughby said Red Bull could be deadly when combined with stress or high blood pressure, impairing proper blood vessel function and possibly lifting the risk of blood clotting.

“If you have any predisposition to cardiovascular disease, I’d think twice about drinking it,” he said.

Restrictive surgeries are operations used to produce weight loss. In a restrictive surgery — like gastric banding — a surgeon uses one of a variety of techniques to reduce the size of the stomach. After restrictive surgery, a person feels full faster, eats less, and loses weight.

The full names for the two types of restrictive surgery for weight loss are:

• Laparoscopic adjustable gastric banding (”Lap banding“)
• Vertical banded gastroplasty

In practice, laparoscopic gastric banding is by far the most common restrictive surgery.

Laparoscopic Adjustable Gastric Banding (’Lap Banding’)

Laparoscopic adjustable gastric banding is often called gastric banding, lap banding, or LAP-BAND(^TM) surgery. Laparoscopic gastric banding is the second most common weight loss surgery, after gastric bypass. More than 250,000 LAP-BAND procedures have been performed worldwide.

Lap banding surgery involves the following:

• Using laparoscopic tools, the surgeon places an adjustable silicone band around the upper part of the stomach.
• Squeezed by the silicone band, the stomach becomes a pouch with about an inch-wide outlet. After banding, the stomach can only hold about an ounce of food.
• A plastic tube runs from the silicone band to a device just under the skin. Saline (sterile salt water) can be injected or removed through the skin, flowing into or out of the silicone band.
• In this way, the band can be tightened or loosened as needed. This can reduce side effects and improve weight loss.

Laparoscopic adjustable gastric banding leads to loss of about 40% of excess weight, on average. Someone people who are 200 pounds overweight could expect to lose an average of 80 pounds after gastric banding. However, these results vary widely.

Gastric banding is considered the least invasive weight loss surgery. It is also the safest. The procedure can be reversed if necessary, and in time, the stomach generally returns to its normal size.


Lap banding surgery has a low complication rate. The most common problems after lap banding surgery include:

• Nausea and vomiting. These can often be reduced by adjusting the tightness of the LAP-BAND.
• Minor surgical complications occur less than 10% of the time. These include problems with the adjustment device, wound infections, or minor bleeding.
• The risk of death due to lap banding surgery is about 1 in 2,000.

Unlike gastric bypass surgery, lap banding does not interfere with food absorption. For this reason, vitamin deficiencies are rare after lap banding.

Vertical Banded Gastroplasty (VBG)

Vertical banded gastroplasty also involves a plastic band placed around the stomach. In addition, the surgeon staples the stomach above the band into a small pouch.

Vertical banded gastroplasty results in less weight loss, compared with other surgeries. It also has a higher complication rate. For these reasons, vertical banded gastroplasty is less common today. Only 5% of bariatric surgeons still perform this surgery.

Mixed Surgeries (Restrictive and Malabsorptive)

Restrictive surgery is an important part of nearly all weight loss surgeries. In the most common weight loss surgery, gastric bypass surgery, restrictive surgery is first done on the stomach. This “stomach stapling” creates a small stomach pouch.

The new stomach pouch is reconnected to a part of the small intestine further down. This leads to less food eaten (restrictive) and less food absorbed (malabsorptive).

Omega-3 pill worked slightly better than cholesterol medication, study says

Fish oil supplements may work slightly better than a popular cholesterol-reducing drug to help patients with chronic heart failure, according to new research released Sunday.

Chronic heart failure is a condition that occurs when the heart becomes enlarged and cannot pump blood efficiently around the body.

With few effective options for heart failure patients, the findings could give patients a potential new treatment and could change the dietary recommendations for them, said Dr. Jose Gonzalez Juanatey, a spokesman for the European Society of Cardiology, who was not connected to the research.

“This reinforces the idea that treating patients with heart failure takes more than just drugs,” Juanatey said.

The study findings were published online in the medical journal The Lancet on Sunday. They were simultaneously announced at a meeting of the European Society of Cardiology in Munich.
http://doctorsurgerycenter.com/blog
“With a lot of these patients, you have no other choice,” said Dr. Helmut Gohlke, a cardiologist at the Heart Centre in Bad Krozingen, Germany. “They’ve tried other treatments and are at the end of the road.”

Italian researchers gave nearly 3,500 patients a daily omega-3 pill, a prescription-formulation pill derived from fish oils, produced by Norway’s Pronova BioPharma.

Same benefit from eating oily fish
But doctors said people should get the same benefits from taking cheaper options like fish oil supplements — or just eating more oily fish like salmon.

Roughly the same number of patients were given placebo pills. Patients were followed for an average of four years.

In the group of patients taking the fish oil pills, 1,981 died of heart failure or were admitted to the hospital with the problem. In the patients on placebo pills, 2,053 died or were admitted to the hospital for heart failure.

In a parallel study, the same team of Italian doctors gave 2,285 patients the drug rosuvastatin, also known as Crestor, and gave placebo pills to 2,289 people. Patients were then tracked for about four years. The doctors found little difference in heart failure rates between the two groups.

Comparing the results from both studies, the researchers concluded that fish oil is slightly more effective than the drug because the oil performed better against a placebo than did Crestor.

“It’s a small benefit, but we should always be emphasizing to patients what they can do in terms of diet that might help,” said Dr. Richard Bonow, chief of cardiology at Northwestern University Hospital in Chicago and past president of the American Heart Association.


Both studies were paid for by an Italian group of pharmaceuticals including Pfizer Inc., Sigma Tau SpA and AstraZeneca PLC.

Omega-3 fatty acids offer brain benefits
Omega-3 fatty acids from fish such as salmon and tuna have long been proven to offer health benefits like protecting the heart and brain, though scientists aren’t exactly sure how.

Bonow said that since cell membranes are made of fatty acids, fish oils may help to replace and strengthen those membranes with omega-3.

Fish oils also are thought to increase the body’s good cholesterol levels, as well as possibly stabilizing the electrical system in heart cells, to prevent abnormal heart rhythms.

In contrast, statins act on the body’s bad cholesterol, which may not have a big impact on heart failure.

Previous studies that investigated the benefits of omega-3 fatty acids have largely been observational, and have lacked a direct comparison to a placebo. It has also been unknown whether taking fish oil supplements would be as good as eating fish.

“This study changes the certainty of the evidence we have about fish oils,” said Dr. Douglas Weaver, president of the American College of Cardiology.

Weaver said that guidelines in the United States would likely change to recommend that more heart patients eat more fish or take supplements. “This is a low-tech solution and could help all patients with cardiovascular problems.”

Avoid a sandal scandal

Is a bunion, corn, ingrown toenail or a bad case of athlete’s foot causing
you foot pain or embarrassment? Keep your feet healthy by learning to recognize
and treat common foot problems.

The bunion, or misaligned bones in the big
toe, is clearly visible.

Bunion

A bony bump at the base of the big toe, a bunion causes that toe to deviate
toward the others. Throwing foot bones out of alignment and producing the
characteristic bump at the joint’s base, a bunion can be very painful due to
pressure or arthritis, and may also lead to corns. Pain relievers, pads to
cushion the bunion, custom shoe inserts, or surgery may help, as will wearing
roomy shoes and avoiding high heels.

(Left) corn; (right) callus.

Corns and calluses

Friction causes the thick, hardened, dead skin of corns and calluses, which
form to protect sensitive skin. Appearing cone-shaped, corns point into the
skin, and usually occur on areas that bear little weight. Calluses may appear
anywhere there’s friction, and are more diffuse. Both may be caused by
ill-fitting shoes and will fade when friction stops. Moleskin pads can help
relieve a corn; calluses can be trimmed or surgically corrected.

‘Gouty toe’ is characterized by swelling,
redness, and stiffness and pain.

Gout

A form of arthritis, gout is characterized by sudden pain, redness, swelling,
and stiffness, usually in the large joint of the big toe. Gout can also occur in
the foot, ankle, or knees. It and is caused by too much uric acid (UA) in the
blood, which can form hard crystals in joints. Attacks can last days or weeks,
and may be treated with anti-inflammatories or UA-lowering medication. Talk to
your doctor about diet changes that help break down UA.

Plantar warts look like hard, thick patches
of skin with dark specks.

Plantar warts

Plantar warts are tough, horny growths that develop on the soles of the feet.
Contagious, they’re caused by a virus entering through broken skin, and often
spread via public pools and showers. Plantar warts are harmless and can be left
untreated, but in many cases they’re too painful to ignore. Topical salicylic
acid may help, while burning, freezing, laser therapy, and surgical removal are
more aggressive options for more severe cases.

Interdigital, or toe web infection, is the
most common kind of athlete’s foot.

Athlete’s foot

A fungal infection that can cause peeling, redness, itching, burning, and
sometimes blisters and sores, athlete’s foot is mildly contagious, passed by
direct contact or by walking barefoot in areas such as locker rooms, or near
pools. The fungi then grow in shoes, especially tight ones without air
circulation. Athlete’s foot is usually treated with topical antifungal lotions
or oral medications for more severe cases.

Fungal infections occur in toenails more
often than in fingernails.

Fungal nail infection

Occuring when microscopic fungi enter through a break in the nail, a fungal
infection can make your nails thick, discolored and brittle. If left untreated,
the nail infection won’t go away — and can be hard to treat. Thriving in warm,
wet places, the fungi can be spread from person to person. Topical creams may
help mild cases but antifungal pills are your best chance of curing a severe
infection.

Hammertoe generally causes the middle joint
of the toe to bend downward.

Hammertoe

When toe muscles get out of balance, they can cause painful toe problems.
While some people are prone to hammertoe, other risks include tight footwear.
Hammertoe generally causes the middle joint of the toe to bend downward, with
toes appearing raised near the foot. Well-fitted footwear with the correct
amount of space in the toe box, shoe supports, and surgery may offer relief.

Ingrown toenails usually occur in the big
toe.

Ingrown toenail

A toenail that has grown into the skin, an ingrown toenail can result in
pain, redness, swelling, even infection. Cutting nails too short or not straight
across, injury to the toenail, and wearing tight shoes are culprits. For mild
cases, soak the foot in warm water, keep it clean, and wedge a small piece of
cotton under the corner of the ingrown nail to lift it off the skin. Minor
surgery can remove all or part of the nail.

Flatfoot can occur in one or both feet.

Flatfoot (pes planus)

Flatfoot is characterized by the sole of the foot coming into complete or
near-complete contact with the ground. It may be inherited, caused by an injury,
or by a condition, such as rheumatoid arthritis. Flatfoot symptoms are rare,
though weight gain, ill-fitting shoes, or excessive standing may cause pain.
Treatment includes foot-strengthening exercises, and shoes with good arch
support or orthotics.

Pain that lasts for 3 months or longer is called chronic. Pain is your body’s way of telling you that something is wrong. It’s normal for you to have pain when you are injured or ill. But pain that lasts for weeks, months, or years is not normal.

Chronic pain can occur anywhere in your body. It can range from being mild and annoying to being so bad that it gets in the way of your daily activities.

Anyone can get chronic pain. It’s more common in older adults, but it’s not a normal part of aging. Older adults are more likely to have long-term medical problems, such as diabetes or arthritis, which can lead to ongoing pain.

What causes chronic pain?

The cause of chronic pain is not always clear. It may occur because brain chemicals that usually stop pain after you get better from an illness or injury are not working right. Or damaged nerves can cause the pain. Chronic pain can also occur without a known cause.

What are the symptoms?

Common symptoms of chronic pain include:

• Mild to very bad pain that does not go away as expected.
• Pain that is shooting, burning, aching, or electrical.
• Soreness, tightness, or stiffness.

What other problems can chronic pain cause?

If you have pain for a long time, it can make you feel very tired and may lead to depression. It can get in the way of your usual social and physical activities. You may have so much pain that you can’t go to work or school. The emotional upset may make your pain worse. Your body’s defense system (immune system) may get weak, leading to lots of infections and illnesses.

How is chronic pain diagnosed?

Your doctor can find out if you have chronic pain by asking about your past illnesses and your overall health. He or she will also do a physical exam.

You may have tests to find out if a medical problem is causing the pain. Your doctor may check for problems with your nervous system and may order blood tests. He or she may also ask you questions to check your mood and mental health and to see how well you are able to think, reason, and remember. In most cases, test results are normal. This can make it hard to know the exact cause of the pain. But this doesn’t mean that your pain isn’t real.

How is it treated?

You can use home treatment for mild pain or pain that you have now and then. Exercising, getting enough sleep, and eating healthy foods may help reduce chronic pain. Using over-the-counter pain medicines such as acetaminophen, aspirin, or ibuprofen may also help. You may want to try complementary therapies such as massage and yoga.

Talk to your doctor if your pain does not go away or if it gets worse. You may need to try different treatments to find what works for you. Medicines you take by mouth, shots of numbing medicine, acupuncture, nerve stimulation, and surgery are used for some types of chronic pain. It is important to make a clear treatment plan with your doctor. The best plan may include combining treatments.

Living with chronic pain can be hard. Counseling may help you cope. It can also help you deal with frustration, fear, anger, depression, and anxiety. Chronic pain often can be managed so that you can get on with your life and do your daily activities.

There are now natural options for men wanting to grow breasts that look, feel and contour just like that of a woman. The amount of growth depends on the supplement or method chosen for augmentation, the amount of time on the chosen product or system, and some other lifestyle factors such as diet, massage and exercise that can help lead the way to successful enlargement of the male breast.

The natural phenomena of male breast enlargement is called gynecomastia, an often unwanted side effect caused by imbalances in hormones, and excess weight.

For men who desire to grow female-like breasts, the options are almost identical to a women’s options for nonsurgical augmentation. While men can also undergo surgical breast augmentation, it may be more difficult due to a lack of protruding flesh to work with, since most men do not have a lot of extra tissue in the chest area to be conducive to implant insertion. Because of this, male breast augmentation surgeries can often come out looking more un-natural than usual, due to a lack of fleshy tissue to cover the round, and sometimes hard looking implant.

This is precisely why men, whether they be transgender or simply have a fetish desire to grow breasts, are looking for better and more effective and natural looking options to enlarge their chest. There are countless success stories from men who have tried natural breast enhancement products, just like women, and experienced excellent results with adequate length of time on the product, as well as proper and consistent usage.

Biological male breast tissue does not behave all that differently from female breast tissue. When exposed to the right amount of external stimulation factors, as well as the right formula for hormonal and glandular stimulation, the environment for additional breast growth is created.

How Can A Man Achieve Successful Breast Growth?

Men are subject to the same guidelines as women too in most cases, and for most male breast enhancement products the same guidelines apply. It is advisable to combine breast massage as a stimulating factor to set the stage for maximum “breast expansion” while adhering to a natural enhancement routine.

This is most effective when the massage is done with a quality serum or cream formulated with external stimulating factors, such as caffeine (although caffeine should not be orally taken while on a supplement - it will dilute the effectiveness of the product usually), and other stimulating ingredients containing plant estrogens and firming and toning tonics.

Some lighter chest exercises will help to lift the pectoral muscles so that the breast tissue that is currently there and any subsequent breast growth from supplementation is forced outward. This also helps to round, tone and firm the breast area for a fuller look that is more feminine and curvaceous. This may include some lightweight chest flies, modified push ups, light squeezing of the lateral pectoral muscles, or the muscles that run up the side of the breast.

A balanced diet is always recommended for men on breast supplements. A balanced diet creates an ideal environment that is more conducive to breast growth by regulating the hormones and allowing a supplement to better perform its duties.

Men wanting to grow breasts have some excellent options. The effectiveness of natural supplementation has been proven through personal testimonials and even pictures have been documented proving its effectiveness on biological males. So if you are a male looking to enhance your current breast size and further feminize your body, there are options out there - you just need to pick the right product or regimen for you.

Maintaining mental acuity is a major concern for aging Americans; they want to make the most of their golden years rather than have to struggle through them. In fact, adults are more than twice as likely to fear losing their mental capacity as their physical capacity, according to a 2006 poll by Research!America, a nonprofit public education and advocacy alliance.

While many know the basics when it comes to keeping their minds sharp (stick with those crosswords), a crop of new research is showing that lifestyle choices may play an even bigger role than people realize, particularly in terms of memory. Factors—some positive, some negative—range from diet to unlikely medications and hormonal changes.

“Most people feel that they are victims when it comes to Alzheimer’s and memory loss,” says Dr. Vincent Fortanasce, author of the new book The Anti-Alzheimer’s Prescription.

But Fortanasce points out that there’s a difference between mental agility, which is our ability to multi-task and do things quickly, and mental capacity, which is our ability to reason and use our experience. When we age, just as we naturally lose physical agility, we lose mental agility. But you can do something about, even increase, your mental capacity as you grow older, Fortanasce says.

How and what we eat

Fortanasce’s four-step method for staving off Alzheimer’s includes dietary advice that stresses the importance of balance in the foods you consume (one-third carbohydrates, one-third protein, one-third fat) as well as the order in which you eat them.

By regularly gorging on the white bread that’s complimentary at restaurants, you’re spiking your insulin. You may also be causing the insulin-degrading enzyme that exists in the brain to work overtime removing insulin, rather than getting rid of beta-amyloid proteins, the toxic protein that produces Alzheimer’s disease. Carbohydrates are to the brain what cigarettes are to the lungs, Fortanasce says.

Research published in the latest issue of the journal Neurology also shows that eating fish may help prevent memory loss and stroke in healthy, older adults. The study looked at the brain scans of more than 2,300 people age 65 and older. It found that those who ate broiled or baked tuna and other fish high in omega-3 fatty acids (salmon, mackerel, anchovies) three or more times per week had a nearly 26% lower risk that the silent brain lesions would be linked to dementia and stroke.

There was no benefit for those who ate fried fish or skipped it altogether, says Dr. David Siscovick, study author and professor of medicine and epidemiology at the University of Washington.

The wrong dietary choices can have a significantly adverse impact. Consider a study out of Loughborough and Oxford Universities last month, funded by the Alzheimer’s Research Trust, concerning the high consumption of soy foods, such as tofu.

Of 700 elderly Indonesians, those who ate tofu at least once a day had an increased risk of dementia or memory loss, particularly if they were over age 65. Researchers believe the link might be due to soy products’ phytoestrogens, which may offer some neural benefits to the middle-aged and young but could harm those over 65.

The estrogen effect

The side effects of changes in estrogen in some midlife women may also explain their forgetfulness.

A new study out of the University of Illinois at Chicago shows for the first time that the more hot flashes a woman has, the worse her memory performance, or recollection of words, names, paragraphs and stories. By using monitors to record subjects’ hot flashes, researchers also found that women tend to underreport the number of hot flashes they experience by more than 40%. In other words, women may be frequently experiencing the menopausal symptom and its effects without realizing it.

“What comes from this is women can have the comfort of knowing this is really just a physiological event,” says Pauline Maki, University of Illinois at Chicago associate professor of psychiatry and psychology and the study’s lead author.

Medicine and the mind

Another new study surprisingly shows that taking cholesterol-lowering statins may be good for the mind, possibly due to the drugs’ ability to lower high insulin levels in the brain that are associated with dementia. The research looked at Mexican Americans with metabolic conditions that put them at high risk for dementia, Alzheimer’s or cognitive impairment. Taking statins for five to seven years may cut a person’s risk of dementia by half, says Mary Haan, epidemiology professor at the University of Michigan School of Public Health and lead author of the study.

That’s not a good enough reason on its own to start taking statins yet, since the U.S. Food and Drug Administration hasn’t approved the medication for this particular use, and it’s not clear which statins might provide the most brain benefits. But the research shows how, often unknowingly, so many of our actions can impact our cognitive function and memory.

As Fortanasce says, “People have more control than they realize.”

Alzheimer’s disease typically develops slowly and causes a gradual decline in cognitive abilities, usually over a span of seven to 10 years. It eventually affects nearly all brain functions, including memory, movement, language, behavior, judgment and abstract reasoning.

Dividing the progression of Alzheimer’s disease into stages can help you plan for the future, but remember that not everyone will experience the same symptoms or progress at the same rate. While each individual is different, the progression of his or her disease can be roughly divided into three stages — mild, moderate and severe.

Mild Alzheimer’s disease

People in the early stage of Alzheimer’s may experience memory loss, lapses of judgment and subtle changes in personality. They often have decreased attention span and less motivation to complete tasks. In addition, they may resist change and new challenges, and get lost even in familiar places.

While everyone occasionally forgets words or names during conversations, this problem occurs with increasing frequency in people with mild Alzheimer’s. They may substitute or make up words that sound like or mean something like the forgotten word. They sometimes even avoid talking to keep from making mistakes and appear subdued or withdrawn — especially in socially or mentally challenging situations.

They may also put things in very odd places. For example, a wallet may end up in the freezer, or clothes may go into the dishwasher. They may ask repetitive questions or hoard things of no value. When frustrated or tired, they may become uncharacteristically angry.

Moderate Alzheimer’s disease

In the middle stage of Alzheimer’s, people can’t organize thoughts or follow logical explanations. They lose the ability to follow written instructions and often need help choosing proper clothing for the season or occasion. Eventually, they’ll require help getting dressed because their confusion may cause them to put their pajamas on over their daytime clothes or their shoes on the wrong feet. They may also have episodes of urinary or fecal incontinence.

It’s usually during this stage that people start having problems recognizing family members and friends. They may mix up identities — thinking a son is a brother or that a spouse is a stranger. They may become confused about where they are and what day, season or year it is. They become unable to recall their address or phone number.

Because they lack judgment and tend to wander, people with moderate Alzheimer’s disease aren’t safe on their own. They may exhibit restless, repetitive movements in late afternoon, or continually repeat certain stories, words or motions, such as tearing tissues.

Problems with communication worsen during the moderate stage of Alzheimer’s. This can lead to a variety of challenging behaviors, including:

• Paranoia that sometimes provokes accusations of infidelity or stealing
• Agitation, frustration or anger that can lead to cursing, kicking, hitting, biting, screaming or grabbing

Severe Alzheimer’s disease

People in the last stage of Alzheimer’s require help with all their daily needs. They lose the ability to walk without assistance and then the ability to sit up without support. They are usually incontinent and may no longer speak coherently. They rarely recognize family members. Swallowing difficulties can cause choking, and they may refuse to eat.

How long?

The rate of progression varies widely among individuals. For some, severe dementia occurs within five years of diagnosis. For others, it can take more than a decade. On average, people with Alzheimer’s live for eight to 10 years after diagnosis. Some live as long as 20 years. Most people with Alzheimer’s don’t die of the disease itself, but of pneumonia, a urinary tract infection or complications from a fall.

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