Alzheimer’s Disease Patients with Psychosis Misdiagnosed at Higher Rates than Previously Thought, Study Finds

 JULY 7, 2017  BY MAGDALENA KEGEL

Patients with Alzheimer’s disease who experience delusions and hallucinations are five times more likely to be misdiagnosed than Alzheimer’s patients without psychosis, new research from St. Michael’s Hospital in Toronto, Canada, found.

The study, “Determining the impact of psychosis on rates of false-positive and false-negative diagnosis in Alzheimer’s disease,” was published in the journal Alzheimer’s & Dementia: Translational Research & Clinical Interventions.

Researchers discovered that Alzheimer’s patients with psychosis were misdiagnosed with another form of dementia in 24% of all cases, compared to previous research that suggested a range of 12-23%. Of the 24% of cases, 12% were false positives and 12% were false negatives, the study showed. 

Psychosis is a typical symptom of other dementia types, and researchers believe that many physicians might be unaware of its link to Alzheimer’s disease.

About 36% of Alzheimer’s patients are thought to have delusions and 18% have hallucinations. Delusions and hallucinations are the two most prominent symptoms of a psychosis.

“Psychosis can be a symptom of Alzheimer’s disease, but it is a defining clinical feature in other types of dementia, including Parkinson’s disease related dementia and dementia with Lewy bodies,” said Corinne Fischer, MD, director of St. Michael’s Memory Disorders Clinic and lead author of the study.

“Consequently, clinicians are more reluctant to diagnose a patient with Alzheimer’s disease when they present with delusions or hallucinations,” she added.

For the study, researchers examined data on 961 people in the National Alzheimer’s Coordinating Center database. The study’s patients were treated at Alzheimer’s disease centers in the United States between 2005 and 2012. Not all of them were alive at the time of diagnosis — some had been diagnosed when doctors detected the telltale amyloid aggregates in their brains during autopsies.

“An advantage of our study is that we used the final clinical diagnosis after years of follow-up, so the rate of misdiagnosis we described is the rate under ideal conditions,” said Winnie Qian, a master’s student in the Neuroscience Research Program at St. Michael’s and study co-author.

“This means that it should be considered a minimum. If you extrapolate that and apply it to the general population, the magnitude of the problem could be much greater,” Qian added.

Dementia with Lewy bodies, like Alzheimer’s, is linked to protein aggregates in the brain. The type of protein, however, is different. When future treatments for both diseases are developed they will likely differ, making a correct diagnosis crucial.

According to Fisher, the study also provides information about factors that contribute to erroneous diagnoses.

“Many dementia patients never receive a definitive clinical diagnosis while they’re alive, so the hope is that by understanding what factors can lead to a misdiagnosis, we can be more accurate and provide patients with the best possible care,” she said.

Earlier studies show that psychotic symptoms are linked to a more rapid disease course with a higher loss of functional abilities. They also pose a heavy burden on caregivers, who are already under significant stress.

https://alzheimersnewstoday.com/2017/07/07/alzheimers-disease-patients-with-psychosis-five-times-more-likely-to-be-misdiagnosed-study-suggests/

Nanotechnology Could Change the Future of Disease Treatment

Lauren Santye, Assistant Editor
Friday, July 07, 2017

A newly released paper offers the most comprehensive overview of exosomes to date, indicating its significant potential to detect and treat disease.

Exosomes are tiny biological nanoparticles ranging from 30 to 130 nanometers in size. They communicate between cells, carrying proteins, lipids, DNA, and RNA. They also help drive biological processes.

In a commissioned paper published in Trends in Molecular Medicine, investigators showed that the potential medical benefits of nanoparticles can be divided into 3 broad categories: detecting disease by acting as disease-specific biomarkers; activating immune responses to boost immunity; and treating diseases by acting as a vehicle for drugs to target tumors directly.

Thus far, several studies have demonstrated the potential benefits of exosomes including improvement of prostate cancer testing, a small-cell lung cancer trial; stem cell-derived exosomes to strengthen heart muscles; regeneration of muscle and tissue; Parkinson’s disease; and diabetes.

The authors believe that exosomes as becoming increasingly promising, but more research needs to be done before they can be translated into new techniques and treatments.

“Our survey of research into exosomes shows clearly that they offer enormous potential as a basis for detecting and treating disease,” said author Steve Conlan. “Further studies are necessary to turn this research into clinical outcomes, but researchers and funders should be very encouraged by our findings. Our own research in Swansea is investigating the use of exosomes and exosome-like synthetic nanoparticles in combatting ovarian and endometrial cancer.

“Progress in this field depends on partnership. As the authorship of our own paper illustrates, researchers in different countries are increasingly working together in nanohealth. Swansea University has wider links with Houston and Portuguese-based researchers in the field. It’s also important to build partnerships outside academia, in particular, with government and companies in the fast-growing sector.”

https://www.specialtypharmacytimes.com/news/nanotechnology-could-change-the-future-of-disease-treatment

Parkinson’s Patients Have a Higher Risk of Developing Melanoma — and Vice Versa, Study Finds

JULY 7, 2017  BY IQRA MUMAL IN NEWS.

Parkinson’s disease patients have a significantly higher risk of developing melanoma, and the opposite is also true, according to a new study. But researchers aren’t sure of the cause.

The study, “Parkinson Disease and Melanoma: Confirming and Reexamining an Association,” was published in the journal Mayo Clinic Proceedings.

Research dating back to 1972 has examined the correlation between the development of Parkinson’s disease and the incidence of melanoma. Many researchers have attributed the higher rates of melanoma in Parkinson’s patients to the drug levodopa, which is commonly prescribed in Parkinson’s disease. Other researchers have suggested a link between Parkinson’s and melanoma without the use of levodopa.

Overall, scientists have not been able to come to a consensus on whether the association is real, and if so, whether it is caused by levodopa.

Researchers at the Mayo Clinic in Rochester, Minnesota, made use of the Rochester Epidemiology Project (REP) medical records of patients from Olmsted County, Minnesota, as a way to obtain a large cohort of patients. They used data from the REP to review the charts of all available Parkinson’s patients and compared the incidence of melanoma to age- and gender-matched controls.

They also examined data on patients who had been diagnosed with conjunctival or uveal melanoma — two forms of eye cancer — and determined how many of them developed Parkinson’s.

Results from this study show that patients with Parkinson’s disease are 3.8-times more likely to have pre-existing melanoma compared to the control group. They also determined that patients with melanoma have a 4.2-times higher risk of developing Parkinson’s. Additional analyses revealed a 35-year cumulative risk of developing Parkinson’s disease in patients with melanoma.

Interestingly, patients with melanoma who did not develop Parkinson’s had a 10.5-fold increased risk of death due to metastatic melanoma compared to patients who have melanoma and Parkinson’s disease, indicating a potential protective effect.

Results from this study suggest a link between Parkinson’s disease and melanoma, but do not support levodopa as the cause.

The researchers note that despite the need for additional research on this topic, physicians treating either disease should stay cognizant of the other disease and monitor signs of development.

“Future research should focus on identifying common genes, immune responses and environmental exposures that may link these two diseases,” the study’s first author, Lauren Dalvin, MD, said in a release. “If we can pinpoint the cause of the association between Parkinson’s disease and melanoma, we will be better able to counsel patients and families about their risk of developing one disease in the setting of the other.”

https://parkinsonsnewstoday.com/2017/07/07/parkinsons-patients-have-a-higher-risk-of-melanoma-and-vice-versa/

Webinar: Psychiatric Manifestations of Parkinson's Disease | APDA

Free Webinar Hosted by University at Albany

Thursday, July 20, 2017, 9:00—10:00AM ET

University at Albany is hosting a free live webcast for medical and public health professionals, featuring guest speaker Guy J. Schwartz, MD, the Assistant Clinical Professor of Neurology at Stony Brook University Medical Center. Guy will be discussing in depth the psychiatric symptoms of Parkinson’s disease, their complex interaction and relationship with medical treatments of the disease, and the uphill battle that therapeutic treatment for these specific symptoms is currently facing.

According to the University at Albany website, attendees will learn the following:

• Recognize the biologic underpinnings of psychiatric symptoms of Parkinson’s disease;
• Identify at least three strategies to reduce the psychiatric adverse effects resulting from treatment for the disease; and
• Describe the impact on quality of life and care-giver burden resulting from the psychiatric symptoms of the disease.

TO REGISTER:

http://ualbany-sph.informz.net/ualbany-sph/event.asp?eid=8614B365-1778-41BD-BD9B-CAF91B81DC26

Call us at 518.402.0330 or e-mail coned@albany.edu if you need assistance.

https://www.apdaparkinson.org/psychiatric-manifestations-webinar-university-albany/

Drug Restores Cells and Memories in Alzheimer’s: Mouse Study

NEUROSCIENCE NEWS     JULY 6, 2017

Summary: A new drug has proven effective at restoring memories and neural connections in mouse models of Alzheimer’s disease. The new drug was originally developed as a treatment for Schizophrenia. While the drug does not destroy amyloid plaques associated with Alzheimer’s, it does allow the plaques to co-exist with neurons.

Source: Yale.

Cortical tissue with plaques stained in blue, and astrocytes responding to drug treatment in red. NeuroscienceNews.com image is credited to the researchers

A new drug can restore memories and connections between brain cells in mice with a model of Alzheimer’s disease, a new Yale-led study suggests.

“The drug completely erased evidence of Alzheimer’s synapse damage and memory loss in mouse models of the disease,” said Stephen Strittmatter, the Vincent Coates Professor of Neurology and senior author of the study appearing July 5 in the journal Cell Reports.

Researchers such as Strittmatter have made significant inroads into understanding the biology of Alzheimer’s disease, but identifying effective and safe treatments has been difficult. It is known that amyloid-beta peptides, the hallmark of Alzheimer’s, couple with prion protein at the surface of brain cells and transmit damaging instructions to the interior of the cell. Yale researchers had previously identified a protein on the cell membrane — metabotropic glutamate receptor 5 or mGluR5 — as the gateway that helps transmit damage from the coupling.

Previous attempts had been made to target mGluR5, but most drugs also disrupt signaling of glutamate, the most common neurotransmitter in the human brain. The new compound, Silent Allosteric Modulation or SAM (BMS 984923), was created by Bristol Myers Squibb as part of its effort to treat schizophrenia. The drug does not restrict neurotransmitter signaling in culture tissue or living mice, the study found. After four weeks of treatment, memory and synapses linking brain cells had been restored in mice with a model of Alzheimer’s.

“The drug does not destroy plaques associated with Alzheimer’s, but allows them to co-exist with neurons,” Strittmatter said.

Yale researchers say the next step is to prepare for preliminary trials of the drug’s effects on humans.

Primary funding for the research comes from the National Institutes of Health.

ABOUT THIS NEUROSCIENCE RESEARCH ARTICLE

Yale’s Laura T. Haas is lead author of the study. Researchers from Bristol-Myers Squibb Research and Development also contributed to the paper.

Source: Bill Hathaway – Yale

Image Source: NeuroscienceNews.com image is credited to the researchers.

Original Research: Full open access research for “Silent Allosteric Modulation of mGluR5 Maintains Glutamate Signaling while Rescuing Alzheimer’s Mouse Phenotypes” by Laura T. Haas, Santiago V. Salazar, Levi M. Smith, Helen R. Zhao, Timothy O. Cox, Charlotte S. Herber, Andrew P. Degnan, Anand Balakrishnan, John E. Macor, Charles F. Albright, and Stephen M. Strittmatter in Cell Reports. Published online July 5 2017 doi:10.1016/j.celrep.2017.06.023

Abstract

Silent Allosteric Modulation of mGluR5 Maintains Glutamate Signaling while Rescuing Alzheimer’s Mouse Phenotypes

Highlights

•A potent mGluR5 SAM blocks Aβo/PrPC but not glutamate signaling

•The mGluR5 SAM rescues age-dependent memory loss in an AD mouse model

•Synapse density is restored by mGluR5 SAM treatment over 4 weeks

•mGluR5 SAM reveals a glutamate-independent AD role with a wide therapeutic index

Summary

Metabotropic glutamate receptor 5 (mGluR5) has been implicated in Alzheimer’s disease (AD) pathology. We sought to understand whether mGluR5’s role in AD requires glutamate signaling. We used a potent mGluR5 silent allosteric modulator (SAM, BMS-984923) to separate its well-known physiological role in glutamate signaling from a pathological role in mediating amyloid-β oligomer (Aβo) action. Binding of the SAM to mGluR5 does not change glutamate signaling but strongly reduces mGluR5 interaction with cellular prion protein (PrPC) bound to Aβo. The SAM compound prevents Aβo-induced signal transduction in brain slices and in an AD transgenic mouse model, the APPswe/PS1ΔE9 strain. Critically, 4 weeks of SAM treatment rescues memory deficits and synaptic depletion in the APPswe/PS1ΔE9 transgenic mouse brain. Our data show that mGluR5’s role in Aβo-dependent AD phenotypes is separate from its role in glutamate signaling and silent allosteric modulation of mGluR5 has promise as a disease-modifying AD intervention with a broad therapeutic window.

“Diffusion tensor MRI tractography reveals increased fractional anisotropy (FA) in arcuate fasciculus following music-cued motor training” by Emma Moore, Rebecca S. Schaefer, Mark E. Bastin, Neil Roberts, and Katie Overy in Brain & Cognition. Published online June 12 2017 doi:10.1016/j.bandc.2017.05.001

http://neurosciencenews.com/pharmacology-memory-alzheimers-7041/

Pedal Away Parkinson's set for July 22 in Kaysville

July 6, 2017, Desert News, Utah

The 12th annual Pedal Away Parkinson’s 10-mile family fun ride is set for Saturday, July 22, Gailey Park, 200 S. 300 West, at 8 a.m.

KAYSVILLE — The 12th annual Pedal Away Parkinson’s 10-mile family fun ride is set for Saturday, July 22, Gailey Park, 200 S. 300 West, at 8 a.m.

The fundraiser, established in 2006, supports the Mountain West Parkinson Initiative's community, wellness, education, and outreach programs for Parkinson’s disease.

The entrance fee $15 for adults and $10 for children under 12 if participants register before Wednesday, July 19. Day-of registration, which will begin at 7 a.m., is $20 for adults and $15 for children under 12.

Participants will receive a ride T-shirt and raffle ticket for prize drawings. Following the race there will also be live music, food, face painting and games.

To register, or for more information, log on to pedalawayparkinsons.com.

http://www.deseretnews.com/article/865684383/Pedal-Away-Parkinson7s-set-for-July-22-in-Kaysville.html

Scientists uncover the structure of tau filaments from Alzheimer's disease

July 6, 2017

PET scan of a human brain with Alzheimer's disease. Credit: public domain

Researchers at the MRC Laboratory of Molecular Biology (LMB) have, for the first time, revealed the atomic structures of one of the two types of the abnormal filaments which lead to Alzheimer's disease. Understanding the structures of these filaments will be key in developing drugs to prevent their formation. The researchers, whose study is published today in Nature, believe the structures they have uncovered could also suggest how tau protein may form different filaments in other neurodegenerative diseases.

Alzheimer's, the most common neurodegenerative disease, is characterised by the existence of two types of abnormal 'amyloid' forms of protein which form lesions in the brain. Tau forms filaments inside nerve cells and amyloid-beta forms filaments outside cells. Tau lesions appear to have a stronger correlation to the loss of cognitive ability in patients with the disease. 

Almost thirty years ago, scientists at the LMB (including Michel Goedert, one of the senior authors on this paper) identified tau protein as an integral component of the lesions found in Alzheimer's and a range of other neurodegenerative diseases.  But, until now, scientists have been unable to identify the atomic structure of the filaments.

The researchers extracted tau filaments from the brain of a patient who had died with Alzheimer's disease. The filaments were then imaged using cryo-electron microscopy (cryo-EM). Senior author Sjors Scheres and colleagues developed new software in order to calculate the structure of the filaments in sufficient detail to deduce the arrangement of the atoms inside them. 

Sjors Scheres said: "It's very exciting that we were able to use this new technique to visualise filaments from a diseased brain as previous work depended on artificial samples assembled in the laboratory.  Amyloid structures can form in many different ways, so it has been unclear how close these lab versions resembled those in human disease.

"Knowing which parts of tau are important for filament formation is relevant for the development of drugs. For example, many pharmaceutical companies are currently using different parts of tau in tests to measure the effect of different drugs on filament formation; this new knowledge should significantly increase the accuracy of such tests."

Fellow senior author Michel Goedert said: "We have known for almost three decades that the abnormal assembly of tau protein into filaments is a defining characteristic of Alzheimer's disease. In 1998, the dysfunction of tau protein was shown to be sufficient for neurodegeneration and dementia. In 2009, the prion-like properties of assembled tau were identified. These properties allow the abnormal form to convert previously normal forms.

"Until now the high-resolution structures of tau or any other disease-causing filaments from human brain tissue have remained unknown. This new work will help to develop better compounds for diagnosing and treating Alzheimer's and other diseases which involve defective tau."

Dr Rob Buckle, chief science officer at the MRC, which funded the research, said: "This ground-breaking work is a major contribution to our understanding of Alzheimer's disease. Nearly thirty years ago scientists at the LMB were the first to discover that tau protein plays a key role in the disease. Knowing the basic structure of these filaments in diseased tissue is vital for the development of drugs to combat their formation.

"This research opens up new possibilities to study a range of other diseases where the accumulation of abnormal protein filaments plays a role, including Parkinson's disease, motor neuron disease and prion diseases."

More information: Anthony W. P. Fitzpatrick et al. Cryo-EM structures of tau filaments from Alzheimer's disease, Nature (2017). DOI: 10.1038/nature23002

Journal reference: Nature

Provided by: Medical Research Council

https://medicalxpress.com/news/2017-07-atomic-protein-tangles-alzheimer-disease.html

Expanded medical cannabis law in effect-Georgia

July 7, 2017  

• By SARAH FAY CAMPBELL
• 
  

COURTESY OF GEORGIA GOVERNOR'S OFFICE

As of July 1, several new conditions are eligible for treatment with cannabis oil, under Georgia’s expanded program allowing the use of a medicine derived from marijuana.

Anyone under hospice care, whether inpatient or outpatient, is eligible to be treated the cannabidiol oil, as long as a doctor signs the paperwork for the patient to receive a registration card from the state.

Other new conditions include severe autism in children and any form of autism in adults, the skin disease epidermolysis bullosa and severe or end-state Alzheimer’s, AIDs, peripheral neuropathy and Tourette’s syndrome. 

Senate Bill 16, which expanded the state’s medical cannabis law, took effect July 1. Other conditions that were already approved are seizure disorders, Crohn’s disease, mitochondrial disease, cancer when it is severe or end-stage or when cancer treatment creates wasting illness or severe nausea or vomiting, and severe or end-stage Amyotrophic Lateral Sclerosis, multiple sclerosis, Parkinson’s disease and Sickle cell disease. 

Amyotrophic Lateral Sclerosis was formerly called Lou Gehrig’s Disease, named for a baseball player who had ALS.

To receive a card allowing the possession and use of the oil, patients must have a doctor who will fill out the certification paperwork. 

The oil can contain up to 5 percent THC, the primary ingredient responsible for the marijuana high. The primary active ingredient in the oil is cannabidiol, another compound found in marijuana. Under the law, the oil must be in a pharmaceutical container that states the percentage of THC. 

Though the possession and use of the oil is legal for those with a registration card, the law doesn’t address how someone is to acquire the oil. The oil is not legally available in the state of Georgia, though some companies in Colorado will ship certain low-THC varieties.

Earlier versions of an expansion bill contained several additional conditions including chronic pain, post-traumatic stress disorder and autoimmune disease. Those conditions were in a version that passed the Georgia House of Representatives, but that bill was a no-go in the state Senate. 

Cowetan Stefanie Anderson has chronic pain and fibromyalgia and has been following the expansion actions in Georgia. 

She was disappointed that chronic pain was removed. “I’ve never had any interest in ‘drugs.’ But I’m so sick of feeling this awful, even on prescription meds,” she said. 

Other Coweta women said they wished the state would allow the oil for the pain of arthritis and endometriosis, as well as bipolar disease, anxiety and depression. 

Anderson is hopeful that fibromyalgia or chronic pain will one day be added to the state’s list of approved conditions. “I want to see if I can get relief,” she said.

http://times-herald.com/news/2017/07/expanded-medical-cannabis-law-in-effect

Lawsuit Challenges Florida’s Medical Marijuana Smoking Ban

July 6, 2017

Representatives of Florida for Care filed litigation Thursday challenging a statewide ban on medical cannabis smoking.

The suit was expected after lawmakers approved legislation (SB 8A) in June amending Amendment 2 — a voter initiated constitutional amendment permitting the use and distribution of medical cannabis. Seventy-one percent of voters approved the amendment in November.

Senate Bill 8A amends the definition of medical cannabis in a manner that prohibits “marijuana in a form for smoking” and that bars the personal possession of herbal cannabis flowers, except in instances where they are contained “in a sealed, tamper-proof receptacle for vaping.”

The Florida for Care suit argues that these changes inconsistent with the constitutional definition of marijuana, as passed by voters, and therefore should not be implemented.

The lawsuit argues, “Inhalation is a medically effective and efficient way to deliver tetrahydrocannabinol (THC), and other cannabinoids, to the bloodstream. … By redefining the constitutionally defined term ‘medical use’ to exclude smoking, the Legislature substitutes its medical judgment for that of ‘a licensed Florida physician’ and is in direct conflict with the specifically articulated Constitutional process.”

Under the revised law, patients diagnosed with cancer, epilepsy, glaucoma, HIV/AIDS, PTSD, ALS, Crohn’s disease, Parkinson’s disease, or multiple sclerosis — or who suffer from chronic pain related to any of these diseases — are eligible to receive a 70-day supply of cannabis-infused oils or edible products from a limited number of state-licensed dispensing facilities.

NORML has long argued against regulations that limit or prohibit patients’ access to whole-plant cannabis in lieu of cannabis-derived extracts or pills.

Cannabis inhalation is not associated with increased instances of lung cancer, COPD, or other tobacco-related adverse effects on pulmonary function.

Inhaled cannabis is fast acting and permits patients to accurately self-regulate their dose.

By contrast, non-herbal forms of cannabis possess delayed onset and their effects can often be far less predictable than those of herbal cannabis.

Many patients seeking rapid relief of symptoms do not benefit from pills, tinctures, or edibles, and such restrictions unnecessarily limit patients’ choices.

If the court invalidates SB 8A, the task of writing the rules for implementing the initiative — which must be operational by October — will fall to the Florida Department of Health.

http://www.thedailychronic.net/2017/74301/florida-lawsuit-filed-challenging-medical-cannabis-smoking-ban/

FoxFeed Blog WATCH NOW: Athlete with Parkinson's Jimmy Choi Becomes an American Ninja Warrior

Posted by  

Allison Boiles

,  July 04, 2017

Jimmy Choi, 41, is a husband and father of two who was diagnosed with Parkinson's disease (PD) at 27. He's an MVP Team Fox athlete who has run, cycled and swam in countless races and endurance events to help speed a cure -- so many that we at The Michael J. Fox Foundation (MJFF) have lost count! And since he joined Team Fox in 2012, he's raised more than $100,000 to support Parkinson's research.

At MJFF, we've known for some time that Jimmy is a warrior. On Monday, July 3, he showed the world. 

Jimmy brought his exceptional talents, spirit and determination to the homes of millions who tuned in to watch American Ninja Warrior, NBC's obstacle-course competition. In true Team Fox spirit, Jimmy and his family rallied their community around the night by hosting a viewing party in his neighborhood and organizing a raffle for donors.

Complete with his Team Fox t-shirt and cheering section, Jimmy took on the difficult course, once again proving his status as an ultimate athlete. While thrilling viewers with his stamina and agility, Jimmy spotlighted the need of a cure for Parkinson's and educated new audiences on what it means to live with the disease. Watch the entire segment below to see if Jimmy advances to the next round of competition! And keep your eyes peeled for a message from a special fan of Jimmy's, Michael J. Fox.

https://youtu.be/rAO01BNEJkk

Athletic feats are just one of many ways you can help speed a cure. Join Team Fox today and turn your passions and talents into fundraisers to put an end to Parkinson's disease. Learn more at teamfox.org.

Watch Jimmy in action again as he talks about his journey with PD and the importance of exercise as a part of his regimen in our Parkinson's 360 multimedia toolkit.

https://www.michaeljfox.org/foundation/news-detail.php?tune-in-athlete-with-parkinson-jimmy-choi-becomes-an-american-ninja-warrior

Adaptive clothes for those with medical problems

OLDER BUT GOOD:  March 2017

Putting on clothes can be a knotty task for elderly people with medical problems that hinder their regular movements.

A stroke, for instance, can result in a person losing mobility and strength, as can arthritis and Parkinson's disease.

Simple tasks, such as buttoning a shirt or pulling up a zip, suddenly become a frustrating experience for them. These people may need help from a caregiver, but, even so, it can be a demeaning and tricky process for both parties.

One way to make things easier is to use "adaptive apparel", said Ms Punithamani Kandasamy, a registered nurse and caregiving trainer at Active Global Specialised Caregivers.

Adaptive clothes have details like Velcro tabs instead of zips and buttons, as well as adjustable or removable components that help to save time and reduce the risk of injury.

"More importantly, this type of clothing improves one's comfort and bolsters self-esteem," she said.

Adaptive clothes are available online, from websites such as Purple Threads and Silverts.com.

Choose materials that are gentle on the skin, said Ms Punithamani. "Where possible, designs and colours should be aligned to the wearer's preference, as well- selected clothes also enhance his psychological well- being."

Meanwhile, therapeutic footwear can be found at retailers like The Diabetic Shop and The Shoe Co.

Ms Punithamani explains how different types of adaptive apparel and footwear can be useful for both the wearer and the caregiver.

Poon Chian Hui

THERAPEUTIC FOOTWEAR

Older people who suffer from arthritis, swollen feet and legs, or who are prone to foot diseases, may benefit from special footwear.

Therapeutic shoes may have removable insoles and arch support, and wedges or heels that prevent injuries. For instance, "rocker bottom" shoes have thick soles that ease pressure on the ball of the foot. The rounded heels help to limit unnecessary motion in the ankle and mid-foot. For people with arthritis, this makes walking less painful.

Extra-wide footwear with adjustable straps are helpful for people with water retention in their feet, as they can accommodate swelling.

ANTI-STRIP JUMPSUITS

This one-piece attire helps to guard against inappropriate disrobing in public, which some people, such as those with dementia, may be inclined to do.

The jumpsuits usually feature long zippers and fasteners at the back, making it challenging for the wearer to take them off by himself.

Loose sleeves and elastic waistbands help to ensure a good fit, without compromising on comfort.

Best of all, the jumpsuits are designed to look like normal two-piece outfits, so one does not feel or look awkward in them.

OPEN-BACK TOPS 

These garments feature a large overlapping flap across the back at each shoulder with snap-on fasteners.

The garment can be slipped on easily from the front, which is like putting on a jacket back to front.

The wearer does not have to raise his arms or struggle with pulling the shirt over his head, making it suitable for people with limited mobility.

The open-back design also allows people with paralysis, Parkinson's disease and arthritis, as well as the wheelchair-bound, to get dressed while seated.

OPEN-SEAT PANTS 

This type of pants can be worn while one is seated. An overlapping flap of cloth covers the buttock area, allowing easy access to the rear. This may be helpful for care- givers of elderly wheelchair users who have urinary or bowel incontinence, for instance.

The pants are easily secured by fasteners at the side or the back of the waist. As they are fairly easy to detach, such pants allow for a quick change.

They are loose enough to accommodate incontinence aids, such as a urinary or faecal collector bag, in a discreet manner.

http://www.straitstimes.com/singapore/health/adaptive-clothes-for-those-with-medical-problems