TOXIC CAUSES OF IDIOPATHIC PARKINSON'S DISEASE

PARAQUAT

Paraquat is a quaternary ammonium herbicide. Other members of this class include

 diquat, cyperquat, diethamqua, difenzoquat and morfamquat. Pesticides are known

 to be associated with an increased rate of Parkinson’s Disease.

 Paraquat structurally resembles MPTP and its metabolite MPP+. MPTP and

 MPP+ are neurotoxic chemicals, that induce Parkinson’s Disease in exposed humans.

Paraquat might therefore might, as do MPTP and MPP+ inhibit tyrosine hydroxylation,

which is essential for the formation of dopamine.

ROTENONE Rotenone is an insecticide that has the potential to cause Parkinson's disease. Insecticides are also known to affect well water. Rotenone is commonly used in powdered  form to treat parasitic mites on chickens and other fowl, and of certain tropical legumes. Rotenone inhibits of dopamine. So rotenone could cause   Parkinson's disease by lowering dopamine levels. When given intravenously to mice, rotenone has been demonstrated to cause a model of Parkinson's disease. Rotenone toxicity is tyrosine hydroxylation, which is essential for the formation also caused by complex I inhibition, depletion of cellular and oxidative damage. These processes cause loss of midbrain  dopaminergic neurons, leading to depletion of dopamine in the brain. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ MANEB Maneb is a fungicide that contains manganese. The major active element of Maneb is manganese ethylene-bis-dithiocarbamate. Pesticides are known to be associated with an increased rate of Parkinson's disease, so there is a greatly increased the  likelihood of developing toxic symptoms by people involved in horticulture and agriculture. As Maneb contains manganese it is possible that it causes Parkinson's Disease symptoms via the same means as manganese, which is by inhibiting tyrosine hydroxylation, which is essential for the formation of dopamine. The effects of Maneb are potentiated when there is also exposure to the pesticide Paraquat. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ MANGANESE Manganese can cause manganism, an irreversible neurological disorder similar to Parkinson's disease. Occupational exposures occur mainly in welding, mining as miners are surrounded by manganese dust and airborne manganese particles, alloy production, processing, ferro-manganese operations  especially in which manganese ore or manganese compounds are turned into steel, and work with agrochemicals. The towns and communities surrounding the areas of manganese heavy industry could also become affected by toxic exposure to manganese. It is also hypothesized that long-term exposure to the naturally-occurring manganese in shower water also puts people at risk. Manganese inhibits tyrosine hydroxylation, which is essential for the formation of dopamine. So manganese may cause Parkinson's disease by lowering dopamine levels. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ MPTP MPTP (1-methyl 4-phenyl 1,2,3,6-tetrahydropyridine) is a chemical that may be  produced accidentally during illicit manufacture of the recreational drug MPPP,  which is a synthetic heroin substitute. The neurotoxicity of MPTP wasdiscovered in 1976  after a chemistry graduate student synthesized MPPP incorrectly and injected the result.  It was contaminated with MPTP, and within three days he began exhibiting symptoms  of acute Parkinson's disease. It was also developed but unused as a herbicide and  was distributed on the streets as a synthetic opioid-like drug.  MPTP inhibits tyrosine hydroxylation, which is essential for the formation of dopamine.  So MPTP causes acute Parkinson's disease by lowering dopamine levels. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ TOLUENE Toluene is a solvent that has been shown to cause Parkinson's Disease, or that has been  associated with people with Parkinson's disease. Toluene is used as an octane booster  in fuel, as a solvent in paints, paint thinners, chemical reactions, rubber, printing,  adhesives, lacquers, leather tanning, disinfectants, and to produce phenol and TNT (a component of explosives). It is also used as a raw material for toluene  di-isocyanate, which is used in the manufacture of polyurethane foams.  The precise means of toxicity of toluene is not known. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ N-HEXANE N-hexane, a constituent of solvents has been shown to cause parkinsonism. Most of the  n-hexane used in industry is mixed with similar chemicals called solvents. The major  use for solvents containing n-hexane is to extract vegetable oils from crops such as soybeans.  These solvents are also used as cleaning agents in the printing, textile, furniture, and shoe   making industries, and also by chemists. Certain glues used in the roofing, and shoe  and leather industries also contain n-hexane. Several consumer products contain n-hexane,  such as gasoline, spot removers, quick-drying glues, and also rubber cement.  The means of  toxicity of n-hexane is still unknown. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ CARBON DISULFIDE Carbon disulfide, usually in solvents or pesticides, can cause Parkinson's disease that is  associated with other neurological symptoms. The toxic effects can persist for years  after exposure to the carbon disulfide has ceased. Potential sources include pesticides  used as fumigants, disulfiram (a drug used in the treatment of chronic alcoholism), i ndustrial solvents, solvents used in the production of viscose rayon and cellophane film.  Means of toxicity is not established. However, carbon disulphide interferes with  pyridoxal 5-phosphate. Pyridoxal 5-phosphate is essential for the formation of  dopamine from L-dopa. So carbon disulphide may cause Parkinson's disease symptoms  by reducing the formation of L-dopa. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ CARBON MONOXIDE Carbon monoxide toxicity is frequent due to the formation of carbon monoxide  by very common means such as gas cookers and exhaust fumes. However, it normally  requires severe exposure (e.g. the person going into a coma as a result of the  carbon monoxide poisoning) before symptoms of Parkinson's disease develop.  Carbon monoxide causes hemoglobin (which transports oxygen) to turn in to  carboxyhemoglobin (which does not transport oxygen). Oxygen is required  for the formation of L-dopa. So carbon monoxide may cause Parkinson's  disease symptoms by interfering with the availability of oxygen to the brain.  However, the means by which it can cause parkinsonism has still not been proven. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ MERCURY Mercury toxicity is a known cause of symptoms that mimic Parkinson's disease, especially  tremor. One of the chief targets of the toxin is the enzyme pyruvate dehydrogenase (PDH).  The enzyme is irreversibly inhibited by severalmercury compounds, the lipoic acid  component of the multienzyme complex binds mercury compounds tightly and  thus inhibits PDH. However, the cause of the symptoms of Parkinson's disease  is likely to be due to the fact that mercury potently causes the release of dopamine,  thereby lowering dopamine levels. Mercury is found in a wide variety of sources:  dietary fish intake, ethnic over-the-counter medications, occupational exposures to mercury  vapour, possession of dental amalgam fillings, gold production, skin ointment, some soaps. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ CYANIDE Cyanide, usually from the consumption of potassium cyanide or sodium cyanide can  result in Parkinsonism. Cyanide is also produced by certain bacteria, fungi, and algae,  and are found in a number of foods and plants, such as unprocessed cassava, cherry pits,  apricot pits, bitter almonds. Hydrogen cyanide is contained in vehicle exhaust  and in tobacco smoke, as does burning plastic. Cyanides are also found in gold processing.  Cyanide interrupts the electron transport chain in the inner membrane of the   mitochondrion. Cyanide also occupies the place of oxygen in hemoglobin  (which transports oxygen). Oxygen is required for the formation of L-dopa. So carbon   monoxide may cause Parkinson's disease symptoms by interfering with the availability  of oxygen to the brain. However, the precise toxic means by which it causes  Parkinson's disease has still not been proven. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ COPPER Copper accumulates in Wilson's disease, which is associated with Parkinson's disease. Although copper may cause symptoms by other means, there do not appear to be published studies in which copper has otherwise caused Parkinson's disease. This may be because copper is not normally formed in to a vapour or dust that can readily be inhaled or consumed. Copper can be found in high quantities in copper mines, copper cooking pots, copper plumbing, very excessive consumption of copper nutritional supplements. Excess copper can cause the formation of a copper-dopamine complex,  which leads to the oxidation of dopamine to amino chrome. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ LEAD Prolonged exposure to lead can double the likelihood of developing Parkinson’s Disease. Common means of lead poisoning are lead contaminated soil, and ingestion of lead  dust or chips from deteriorating lead-based paints. Lead has also been found in drinking  water, from plumbing fixtures that are either made of lead or have trace amounts of  lead in them. Lead can be found incosmetics in some countries, and in toys such as  many from China. Due to the similarity of their structures, lead can inadvertently replace  iron in enzymatic reactions, but it does not properly function as a cofactor. This might  cause a reduction in L-dopa because iron is an essential cofactor for L-dopa formation.  Lead can also interfere with oxygen transport by reducing hemoglobin biosynthesis. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ TRICHLOROETHYLENE People subjected to chronic industrial exposure of the solvent Trichloroethylene have been  found to have Parkinson’s Disease. Trichloroethylene is a solvent, that is used  extensively in industry and the military and is a common environmental contaminant.  It has been used to extract vegetable oils, in coffee decaffeination, and in the preparation  of flavouring extracts from hops and spices. The precise means of toxicity is unknown. Workers with workstations adjacent to the source of trichloroethylene and who were subjected to chronic inhalation and dermal exposure from handling trichloroethylene-soaked metal parts all had Parkinson's disease. Lesser chronic  respiratory exposure to trichloroethylene led to many features of Parkinsonism,  including significant motor slowing. Under the trade name Tilene, trichloroethylene was used as an anesthetic and as an  inhaled obstetrical analgesic in millions of patients.  Tilene has been found to cause shaking and stiffness.

Positive Results for CVT-301, Inhaled Levodopa Inn Phase 2

National Parkinson Foundation

16 hrs · 

Civitas Therapeutics announced positive results for CVT-301, inhaled levodopa for the treatment of Parkinson’s at the AAN annual meeting last week. CVT-301 is in a Phase 2 clinical trial and it was demonstrated that it is safe and well tolerated by Parkinson’s patients. Inhaled levodopa is being developed to provide Parkinson’s patients with relief from debilitating motor fluctuations, known as Off episodes. We will continue to update the Parkinson’s community about future developments as this enters Phase 3 trials.

Civitas Therapeutics | ABOUT CVT-301

Civitas Therapeutics is developing breakthrough therapies in Parkinson's disease and research.

CIVITASTHERAPEUTICS.COM

Toxic causes of Gulf War illness confirmed: new report

Wednesday 30 April 2014 - 12am

Progress has been made toward understanding the physiological mechanisms that underlie Gulf War illness and identifying possible treatments, according to a report released by a Congressionally mandated panel of scientific experts and veterans.

Treatment research has increased significantly since 2008, and "early results provide encouraging signs that the treatment goals identified in the 2010 Institute of Medicine report are achievable," the Research Advisory Committee on Gulf War Veterans' Illnesses (RAC) said in a report presented Monday to VA Secretary Eric Shinseki by the Committee's scientific director, Roberta White, chair of environmental health at the Boston University School of Public Health.

The Institute, part of the National Academies of Sciences, had forecast that "treatments, cures, and hopefully preventions" could likely be found with the right research.

The RAC report updates scientific research published since the Committee's landmark report in 2008, which established that Gulf War illness was a real condition, affecting as many as 250,000 veterans of the 1990-91 Gulf War.

"The conclusions of the 2008 RAC report had a substantial impact on scientific and clinical thinking about Gulf War illness, as well as the public acceptance of this disorder," said White. The earlier report documented a number of studies that found evidence linking the illness to exposure to pesticides and pyridostigmine bromide (found in anti-nerve gas pills given to troops), as well as other toxic sources.

"Studies published since 2008 continue to support the conclusion that Gulf War illness is causally related to chemical exposures in the combat theater," White said of the new report. "And many studies of the brain and central nervous system, using imaging, EEG and other objective measures of brain structure and function, add to the existing evidence that central nervous system dysfunction is a critical element in the disorder. Evidence also continues to point to immunological effects of Gulf War illness."

Exposure to the nerve gas agents sarin and cyclosarin has been linked in several studies to changes in magnetic resonance imaging (MRI) that are associated with cognitive impairments -- further supporting the nervous-system effects of those agents cited in the 2008 report.

"The Committee concludes that the evidence to date continues to point to alterations in central and autonomic nervous system, neuroendocrine, and immune system functions," the report says.

Studies also continue to show that Gulf War illness is not associated with psychological stressors during the war, the panel said. Rates of PTSD and other psychiatric illnesses in Gulf War veterans are far below the rate of these disorders in veterans of other recent wars, and far below the rate of Gulf War illness.

In addition, the Committee said, new evidence has emerged suggesting that certain exposures may be linked to brain cancer in Gulf War veterans. Studies show that veterans who were most exposed to the release of nerve gas during the destruction of the Khamisiyah arms depot in Iraq have significantly elevated rates of death due to brain cancer.

Veterans who were exposed to the highest level of contaminants from oil well fires also have increased rates of brain cancer deaths, the report says.

The Committee encouraged studies exposing animals to toxic agents involved in Gulf War illness "because they can help to determine treatment targets in subgroups of veterans with specific exposures, for which there are known mechanistic pathways that cause illness and symptoms."

In addition, "results from this work can be useful in protecting the health of future military personnel who will experience these exposures, as well as non-military populations with occupational or environmental exposures."

The panel cited a number of "promising" treatment studies, including those testing certain dietary supplements, intranasal insulin, and continuous positive airway pressure to ease fatigue and pain and improve cognitive function.

While the RAC panel applauded an increase in the number of treatment studies funded by the Department of Defense's Congressionally Directed Medical Research Program, it expressed grave concerns about a lack of research on other health problems and mortality among Gulf War veterans.

"Very little research" has been conducted to determine rates at which veterans have been affected by neurological diseases such as multiple sclerosis or Parkinson's disease, cancers, and reproductive problems, the panel said.

"No comprehensive information has been published on the mortality experience of U.S. Gulf War era veterans after the year 2000," according to the report.

Gulf War illness refers to the chronic symptoms that affect veterans of that conflict at markedly elevated rates, compared to other veterans' groups and to the U.S. population as a whole. Symptoms can vary from person to person, but typically include some combination of widespread pain, headache, persistent problems with memory and thinking, fatigue, breathing problems, stomach and intestinal symptoms, and skin abnormalities.

Monitoring neural function deep in the brain

May 5, 2014:

Before that can happen, neuroscientists need new tools that will let them probe the brain more deeply and in greater detail, says Alan Jasanoff, an MIT associate professor of biological engineering. "There's a general recognition that in order to understand the brain's processes in comprehensive detail, we need ways to monitor neural function deep in the brain with spatial, temporal, and functional precision," he says.Launched in 2013, the national BRAIN Initiative aims to revolutionize our understanding of cognition by mapping the activity of every neuron in the human brain, revealing how brain circuits interact to create memories, learn new skills, and interpret the world around us.

Jasanoff and colleagues have now taken a step toward that goal: They have established a technique that allows them to track neural communication in the brain over time, using magnetic resonance imaging (MRI) along with a specialized molecular sensor. This is the first time anyone has been able to map neural signals with high precision over large brain regions in living animals, offering a new window on brain function, says Jasanoff, who is also an associate member of MIT's McGovern Institute for Brain Research.

His team used this molecular imaging approach, described in the online edition of Science, to study the neurotransmitter dopamine in a region called the ventral striatum, which is involved in motivation, reward, and reinforcement of behavior. In future studies, Jasanoff plans to combine dopamine imaging with functional MRI techniques that measure overall brain activity to gain a better understanding of how dopamine levels influence neural circuitry.

"We want to be able to relate dopamine signaling to other neural processes that are going on," Jasanoff says. "We can look at different types of stimuli and try to understand what dopamine is doing in different brain regions and relate it to other measures of brain function."

Tracking dopamine

Dopamine is one of many neurotransmitters that help neurons to communicate with each other over short distances. Much of the brain's dopamine is produced by a structure called the ventral tegmental area (VTA). This dopamine travels through the mesolimbic pathway to the ventral striatum, where it combines with sensory information from other parts of the brain to reinforce behavior and help the brain learn new tasks and motor functions. This circuit also plays a major role in addiction.

To track dopamine's role in neural communication, the researchers used an MRI sensor they had previously designed, consisting of an iron-containing protein that acts as a weak magnet. When the sensor binds to dopamine, its magnetic interactions with the surrounding tissue weaken, which dims the tissue's MRI signal. This allows the researchers to see where in the brain dopamine is being released. The researchers also developed an algorithm that lets them calculate the precise amount of dopamine present in each fraction of a cubic millimeter of the ventral striatum.

After delivering the MRI sensor to the ventral striatum of rats, Jasanoff's team electrically stimulated the mesolimbic pathway and was able to detect exactly where in the ventral striatum dopamine was released. An area known as the nucleus accumbens core, known to be one of the main targets of dopamine from the VTA, showed the highest levels. The researchers also saw that some dopamine is released in neighboring regions such as the ventral pallidum, which regulates motivation and emotions, and parts of the thalamus, which relays sensory and motor signals in the brain.

Each dopamine stimulation lasted for 16 seconds and the researchers took an MRI image every eight seconds, allowing them to track how dopamine levels changed as the neurotransmitter was released from cells and then disappeared. "We could divide up the map into different regions of interest and determine dynamics separately for each of those regions," Jasanoff says.

He and his colleagues plan to build on this work by expanding their studies to other parts of the brain, including the areas most affected by Parkinson's disease, which is caused by the death of dopamine-generating cells. Jasanoff's lab is also working on sensors to track other neurotransmitters, allowing them to study interactions between neurotransmitters during different tasks.http://www.medicalnewstoday.com/

Monitoring neural function deep in the brain

Wii Video Games May Improve Cognitive Abilities in Parkinson’s Disease

Science News                    - Apr 30 2014

Playing sports games using video consoles such as the Nintendo Wii may improve some cognitive abilities in people with Parkinson’s disease (PD), according to a new study published in Neurology. In this study, Wii games worked as well or better than a computer program designed specifically for cognitive training. In addition, the Wii game console is less expensive and more entertaining than the computer program, researchers say.

People with PD often experience problems with attention and memory, which range in severity from mild cognitive impairment to full-blown dementia. Treating mild cognitive deficits could not only improve a person’s quality of life, but also might delay the onset of dementia. Unfortunately, there are no known medications that can successfully treat mild cognitive impairment in people with PD.

Computer programs designed to enhance cognition can improve cognitive problems in people with or without PD. However, some people find it difficult to apply the cognitive training, which focuses on specific tasks, to situations in their daily lives.

Researchers led by Peter Fuhr, M.D., at the University of Basel, in Switzerland, wondered whether Wii games, which involve movement and were not designed specifically for cognitive training, could improve cognitive abilities like attention, memory and visualization in people with PD, similarly to a cognitive-training computer program. So the researchers randomly assigned 39 people with PD who did not have dementia to two groups: one that played sports games (table tennis, swordplay, archery, and air sports) on the Nintendo Wii, and one that used the CogniPlus computer program, which provides training in specific cognitive abilities such as attention, memory, planning and response.

Each group trained three times per week for four weeks. To avoid falls, people remained seated while playing games on the Wii and also were seated for computer program training. The study participants performed neuropsychological tests before and after their four weeks of training.

Results

• Compared with CogniPlus, Wii training significantly enhanced attention in people with PD.
• Wii training also appeared to improve visualization and memory of specific events better than CogniPlus, although these differences were not statistically significant.

What Does It Mean?

Cognitive impairment can be a frustrating aspect of life with PD. Previous studies have shown that cognitive training can improve memory and attention in people with PD, increasing their quality of life and perhaps delaying the onset of dementia.

In this study, contrary to the researchers’ expectations, Wii video games improved cognitive abilities in people with PD. Not only that, the people with PD who played the Wii games performed even better in tests of attention than those who used CogniPlus training.

In contrast to CogniPlus, Wii sports games are not designed to treat cognitive problems, rather they are meant for entertainment. However, other studies have shown that physical exercise, such as that obtained by using the Wii’s motion-detecting controllers, can improve cognitive abilities. Also, Wii games may enhance people’s ability to learn new tasks, which could better translate to situations they encounter in everyday life.

These results suggest that Wii video games may be a less expensive and more entertaining alternative to computer programs such as CogniPlus. Because many people consider Wii games fun, they may be more likely to play the games than to use computer programs designed for cognitive training, which might seem like work. Also, they could play them at home, without requiring the travel to a doctor’s office or the additional cost often required with cognitive-training programs.

Further research is needed to determine the details such as exactly how video game consoles, such as the Wii, can improve cognitive abilities, whether longer periods of training provide greater benefits, and whether the training actually improves performance in real-life situations. Nevertheless, game consoles represent an inexpensive and fun way to potentially improve cognitive performance. 

Reference: Zimmermann R, Gschwandtner U, Benz N, Hatz F, Schindler C, Taub E, Fuhr P (2014) Cognitive training in Parkinson disease: Cognition-specific vs nonspecific computer training. Neurology 82:1219–1226. DOI: 10.1212/WNL.0000000000000287http://dx.doi.org/10.1212/WNL.0000000000000287

Caregiver Stress

While caregiving can be a rewarding and positive experience, it can be extremely demanding and stressful.  Often, caregivers experience stress which over time can lead to caregiver burnout.  This section provides information about caregiver stress and burnout, tips to reduce the risk of chronic stress, support for caregivers and ways to cope with the demands of caregiving.
Click on a link below to jump to that section:

• Caregiver Stress & Burnout
• Caregiver Support
• Coping Mechanisms

Caregiver Stress & Burnout

Warning Signs of Caregiver Stress¹

• Anger at elder, family, doctors and/or service providers.
• Withdrawal from activities.
• Feelings of being overwhelmed.
• Feelings of anxiety or constant worry.
• Inability to find pleasure in anything anymore.
• Exhaustion and/or sleeplessness.
• Worsening of chronic conditions.
• Irritability.
• Lack of concentration.

Warning Signs of Caregiver Burnout²

• Persistent symptoms.
• Constant anxiety, irritability or anger.
• Feelings of detachment, numbness or exhaustion.
• Continuous self-criticism.
• Withdrawal from usual activities.
• Negligence or hatred of caregiving responsibilities.
• Trouble at work or in relationships.
• Substance abuse.

What Causes Caregiver Burnout³

• Role confusion.
• Unrealistic expectations.
• Lack of control.
• Unreasonable demands.

Tips for Avoiding Caregiving Burnout⁴

• Schedule regular afternoon or evenings out.
• Take time to talk with friends, either in person or on the phone.
• Eat nutritious meals.
• Get enough sleep.
• Exercise regularly.
• Make a list of jobs you could ask for help with.
• Arrange adult day care.
• Join a support group.
• Draw strength from your faith.
• Take time to pamper yourself.
• Plan a weekend getaway.
• Hire a temporary caregiver from a respite care program.

For More Information About Stress & Burnout

• Effects of Stress from WEBMD
• Stress Information from Mayo Clinic
• Stress Information from Psychology Today

 

While these tips can work to reduce caregiver stress, research has indicated that caregiver support is an effective way to reduce caregiver stress and the risk of burnout.  It is important to remember to take care of yourself as well as your care receiver. While it may be difficult, asking for help does not mean failure.
Asking for Help

Asking family and friends for help can be a difficult thing to do.  Many caregivers avoid asking for help and attempt to do everything themselves.  If help is available it is extremely beneficial to the caregiver.  Assistance with caregiving may reduce feelings of stress and burden.  It gives the caregiver someone to share their experiences with and may bring people closer together.
Tips for Asking Family Members or Friends for Help⁵

• Sit down with them in person or find a quiet time to speak on the phone.
• Review the list of the care receiver needs.
• Specifically discuss areas which you think they could help.
• Inquire about whether they would like to help out in a particular area.
• Clearly explain the tasks and what they could do to help.
• Make sure that they understand exactly what would be helpful to you and the care receiver.

How to Build a Support Network⁶

• Make a list of people who can help in the following ways:
• Who can be relied on for specific tasks and assistance.
• Who you can share your feelings with.
• Who can help with transportation.
• Who can stay with your loved one for a while.
• With whom you can go out with and have a good time.
• Who you can go to when you need professional help.
For More Information

• Asking for Help

• St. Vincent's Health
• NY Times
• Support
  • CNN Health
  • Mayo Clinic

Coping Mechanisms for Caregivers

While it is important to reduce stress and find support, it is not possible to completly eliminate caregiver stress. Therefore, coping is a necessary component of caregiving. Some coping strategies that caregivers can use to reduce caregiver stress include respite care and humor.
Respite Care

Caregiving is demanding and caregivers need time off from their caregiving responsibilities to relieve stress and prevent burnout.  Although there are different approaches to respite care the same basic objective exists: to provide the care recipient with planned temporary care to allow the caregiver relief from the daily responsibilities of caregiving.
When Respite Care Might Be Considered⁷

• To provide care while the caregiver is at work or when other obligations need to be met.
• To provide interaction and social opportunities for the care receiver.

Types of Respite

• Adult Day Center⁷: Provides daily, structured programs in a community setting with activities, health-related services and rehabilitation to older adults who need a protective environment due to physical or mental limitations.
• Provides for the caregiver:
• A safe environment for the loved one.
• Flexible yet scheduled times for drop off and pick up.
• The opportunity to take time off from the caregiving duties.
• The opportunity to socialize or exercise.
• Provides for the care recipient:
• The opportunity for interaction and socialization with others.
• The opportunity to partake in a variety of planned activities.
• May provide social and rehabilitative services.
• Opportunities for education, while taking into consideration their hobbies, interests and needs.

• In-home Care Services⁸: A service that provides professional workers who come directly to the caregiver’s home to provide care.  Often the temporary care provider stays on the premises.  This service may not be available in all areas and may be expensive.
• Provides for the caregiver:
• An opportunity for travel when care receiver cannot live independently.
• Ability to transfer caregiving responsibilities to a trained care professional.
• Provides for the care recipient:
• Ability to remain in their own living environment.
• Opportunity to allow the caregiver the ability to take time off while continuing to receive the needed care.

• Assisted Living Respite Care⁸: This service may be provided by assisted living centers when space is available.  The care recipient moves into the assisted living facility to receive temporary housing and care. 
• Provides for the caregiver:
• Ability to leave the care recipient for an extended period of time.
• Peace of mind knowing that care recipient is receiving professional care.
• Ability to test out an assisted living facility without the move being permanent.
• Should be aware that it may cause anxiety and fear in the care receiver if they do not believe that the move is temporary.
• Provides for the care recipient:
• Safe environment with professional care.
• Opportunity to interact with others.

Choosing a Respite Care Program
While many forms of respite care exist, the quality of care provided by respite services may vary.  Therefore, it is important to check out the facility before leaving your loved one.  Also, it is important to consider your care receiver’s specific needs and to determine whether the respite services you are researching can accommodate these needs.  A list of general questions has been provided as an outline to help determine which respite service may be best for the care recipient. ⁹
General Questions

• How are the care providers screened?
• What is the training and level of experience of the care providers?
• How long has the center been in business?
• Is the center licensed and is the license current?
• What is the physical appearance of the center?
• Will caregiver need additional training to meet specific family needs?
• Who supervises the care provided and how are they evaluated?
• What procedures does the program have for emergencies?
• Are families limited to a certain number of hours of service?
• Does the program provide transportation?
• What is the cost of services and how is payment arranged?

For More Information

• Respite Fact Sheets: U.S. Department of Health & Human Services
• Repite Care: HelpGuide
• Respite Information: ALS Association
• Respite Information: Elder Care
• Respite Booklet: U of U Gerontology Center

Humor & Laughter ¹⁰
Besides respite care, humor may reduce caregiver stress.  Humor therapy is defined as the use of humor for the relief of physical or emotional pain and stress.  Humor is a coping mechanism that a caregiver may use repeatedly or in the ‘heat of the moment’.  When a situation with the care receiver has gone awry, laughter may be the best medicine.
Humor

• Is a complementary method to promote health and cope with illness.
• Is generally used to improve quality of life, provide some pain relief, encourage relaxation and reduce stress. 
• May allow people to feel in control of their situations and make the situation seem more manageable. 
• Allows people to release fears, anger and stress, all which harm the body over time.

Laughter

• Appears to change brain chemistry and may boost the immune system. 
• Appears to increase breathing, increase heart rate and increase oxygen use within the body .
• Allows more oxygen to be used by your body which stimulates the circulatory system.
• Exercises the same muscles and organs used for breathing.
• May release endorphins (neurotransmitters in the brain) which help to control pain.

Sources
1. Alzheimer's Association. (2007). Caregiver Stress. Symptoms of caregiver stress. Retrieved on October 21, 2007 from http://www.alz.org/living_with_alzheimers_caregiver_stress_Iwa.asp
2. Modnick, Kemp & White. (2007). Helpguide.org: Are you in danger of burnout? Retrieved on May 17, 2007 from http://www.helpguid.org/elder/respite_care.htm
3. WebMD.Com. (2002). Heart Disease Guide: What cause caregiver burnout? Retrieved October 21, 2007 from http://www.webmd.com/heart-disease/guide/heart-disease-recognizing-caregiver-burnout
4. 4therapy.com. (2007). Easing the stress of caregiving. Retrieved October 21, 2007 from http://www.4therapy.com/consumer/conditions/item.php?uniquied=5585&categoryid=452&
5. Net of Care. (2005). Information & Resources for Caregiving: How to ask for help. Retrieved October 18, 2005 from http://www.netofcare.org/content/getting-started/asking.asp
6. Brandt, A. (2000). Eldercare Online: Overcoming Negative Emotions. Retrieved October 18, 2007 from http://www.ec-online.net/Knowledge/Articles/emotion2.html
7. Cleveland Clinic Health System. (2005). For your health. Retrieved October 18, 2007 from http://www.cchs.net/health/healthinfo/docs/2200/2239.asp?index=9224
8. Seniormag.com. (2007). Respite Care Services. Retrieved October 21, 2007 from http://www.seniormag.com/services/respite.htm
9. Modnick, Kemp & White. (2007). Helpguide.com: Questions to ask about respite programs. Retrieved May 17, 2007 from http://helpguide.org/elder/respite_care.htm
10. American Cancer Society. (200). Humor Therapy. Retrieved October 18, 2007 from http://www.cancer.org/docroot/ETO/content/ETO_5_3X_Humor_Therapy.asp

While caregiving can be a rewarding and positive experience, it can be extremely demanding and stressful.  Often, caregivers experience stress which over time can lead to caregiver burnout.  This section provides information about caregiver stress and burnout, tips to reduce the risk of chronic stress, support for caregivers and ways to cope with the demands of caregiving.
Click on a link below to jump to that section:

• Caregiver Stress & Burnout
• Caregiver Support
• Coping Mechanisms

Caregiver Stress & Burnout

Warning Signs of Caregiver Stress¹

• Anger at elder, family, doctors and/or service providers.
• Withdrawal from activities.
• Feelings of being overwhelmed.
• Feelings of anxiety or constant worry.
• Inability to find pleasure in anything anymore.
• Exhaustion and/or sleeplessness.
• Worsening of chronic conditions.
• Irritability.
• Lack of concentration.

Warning Signs of Caregiver Burnout²

• Persistent symptoms.
• Constant anxiety, irritability or anger.
• Feelings of detachment, numbness or exhaustion.
• Continuous self-criticism.
• Withdrawal from usual activities.
• Negligence or hatred of caregiving responsibilities.
• Trouble at work or in relationships.
• Substance abuse.

What Causes Caregiver Burnout³

• Role confusion.
• Unrealistic expectations.
• Lack of control.
• Unreasonable demands.

Tips for Avoiding Caregiving Burnout⁴

• Schedule regular afternoon or evenings out.
• Take time to talk with friends, either in person or on the phone.
• Eat nutritious meals.
• Get enough sleep.
• Exercise regularly.
• Make a list of jobs you could ask for help with.
• Arrange adult day care.
• Join a support group.
• Draw strength from your faith.
• Take time to pamper yourself.
• Plan a weekend getaway.
• Hire a temporary caregiver from a respite care program.

For More Information About Stress & Burnout

• Effects of Stress from WEBMD
• Stress Information from Mayo Clinic
• Stress Information from Psychology Today

Caregiver Support

While these tips can work to reduce caregiver stress, research has indicated that caregiver support is an effective way to reduce caregiver stress and the risk of burnout.  It is important to remember to take care of yourself as well as your care receiver. While it may be difficult, asking for help does not mean failure.
Asking for Help

Asking family and friends for help can be a difficult thing to do.  Many caregivers avoid asking for help and attempt to do everything themselves.  If help is available it is extremely beneficial to the caregiver.  Assistance with caregiving may reduce feelings of stress and burden.  It gives the caregiver someone to share their experiences with and may bring people closer together.
Tips for Asking Family Members or Friends for Help⁵

• Sit down with them in person or find a quiet time to speak on the phone.
• Review the list of the care receiver needs.
• Specifically discuss areas which you think they could help.
• Inquire about whether they would like to help out in a particular area.
• Clearly explain the tasks and what they could do to help.
• Make sure that they understand exactly what would be helpful to you and the care receiver.

How to Build a Support Network⁶

• Make a list of people who can help in the following ways:
• Who can be relied on for specific tasks and assistance.
• Who you can share your feelings with.
• Who can help with transportation.
• Who can stay with your loved one for a while.
• With whom you can go out with and have a good time.
• Who you can go to when you need professional help.
For More Information

• Asking for Help

• St. Vincent's Health
• NY Times
• Support
  • CNN Health
  • Mayo Clinic

Coping Mechanisms for Caregivers

While it is important to reduce stress and find support, it is not possible to completly eliminate caregiver stress. Therefore, coping is a necessary component of caregiving. Some coping strategies that caregivers can use to reduce caregiver stress include respite care and humor.
Respite Care

Caregiving is demanding and caregivers need time off from their caregiving responsibilities to relieve stress and prevent burnout.  Although there are different approaches to respite care the same basic objective exists: to provide the care recipient with planned temporary care to allow the caregiver relief from the daily responsibilities of caregiving.
When Respite Care Might Be Considered⁷

• To provide care while the caregiver is at work or when other obligations need to be met.
• To provide interaction and social opportunities for the care receiver.

Types of Respite

• Adult Day Center⁷: Provides daily, structured programs in a community setting with activities, health-related services and rehabilitation to older adults who need a protective environment due to physical or mental limitations.
• Provides for the caregiver:
• A safe environment for the loved one.
• Flexible yet scheduled times for drop off and pick up.
• The opportunity to take time off from the caregiving duties.
• The opportunity to socialize or exercise.
• Provides for the care recipient:
• The opportunity for interaction and socialization with others.
• The opportunity to partake in a variety of planned activities.
• May provide social and rehabilitative services.
• Opportunities for education, while taking into consideration their hobbies, interests and needs.

• In-home Care Services⁸: A service that provides professional workers who come directly to the caregiver’s home to provide care.  Often the temporary care provider stays on the premises.  This service may not be available in all areas and may be expensive.
• Provides for the caregiver:
• An opportunity for travel when care receiver cannot live independently.
• Ability to transfer caregiving responsibilities to a trained care professional.
• Provides for the care recipient:
• Ability to remain in their own living environment.
• Opportunity to allow the caregiver the ability to take time off while continuing to receive the needed care.

• Assisted Living Respite Care⁸: This service may be provided by assisted living centers when space is available.  The care recipient moves into the assisted living facility to receive temporary housing and care. 
• Provides for the caregiver:
• Ability to leave the care recipient for an extended period of time.
• Peace of mind knowing that care recipient is receiving professional care.
• Ability to test out an assisted living facility without the move being permanent.
• Should be aware that it may cause anxiety and fear in the care receiver if they do not believe that the move is temporary.
• Provides for the care recipient:
• Safe environment with professional care.
• Opportunity to interact with others.

Choosing a Respite Care Program
While many forms of respite care exist, the quality of care provided by respite services may vary.  Therefore, it is important to check out the facility before leaving your loved one.  Also, it is important to consider your care receiver’s specific needs and to determine whether the respite services you are researching can accommodate these needs.  A list of general questions has been provided as an outline to help determine which respite service may be best for the care recipient. ⁹
General Questions

• How are the care providers screened?
• What is the training and level of experience of the care providers?
• How long has the center been in business?
• Is the center licensed and is the license current?
• What is the physical appearance of the center?
• Will caregiver need additional training to meet specific family needs?
• Who supervises the care provided and how are they evaluated?
• What procedures does the program have for emergencies?
• Are families limited to a certain number of hours of service?
• Does the program provide transportation?
• What is the cost of services and how is payment arranged?

For More Information

• Respite Fact Sheets: U.S. Department of Health & Human Services
• Repite Care: HelpGuide
• Respite Information: ALS Association
• Respite Information: Elder Care
• Respite Booklet: U of U Gerontology Center

Humor & Laughter ¹⁰
Besides respite care, humor may reduce caregiver stress.  Humor therapy is defined as the use of humor for the relief of physical or emotional pain and stress.  Humor is a coping mechanism that a caregiver may use repeatedly or in the ‘heat of the moment’.  When a situation with the care receiver has gone awry, laughter may be the best medicine.
Humor

• Is a complementary method to promote health and cope with illness.
• Is generally used to improve quality of life, provide some pain relief, encourage relaxation and reduce stress. 
• May allow people to feel in control of their situations and make the situation seem more manageable. 
• Allows people to release fears, anger and stress, all which harm the body over time.

Laughter

• Appears to change brain chemistry and may boost the immune system. 
• Appears to increase breathing, increase heart rate and increase oxygen use within the body .
• Allows more oxygen to be used by your body which stimulates the circulatory system.
• Exercises the same muscles and organs used for breathing.
• May release endorphins (neurotransmitters in the brain) which help to control pain.