Heart attack and cognitive impairment

Mild cognitive impairment, especially memory loss, is prevalent in patients with heart failure and contributes to poor clinical outcomes and higher mortality. A study completed in February looked at this issue. The primary aim of this study (Exercise and Cognitive Training as a Strategy to Improve Neurocognitive Outcomes in Heart Failure: a pilot study) was to evaluate the efficacy of an aerobic exercise (walking) and cognitive training intervention on cognitive function compared to exercise alone. 

While heart failure is distressing alone, its interaction with cognitive decline creates a downward spiral. The study authors point out that heart failure “negatively impacts function in most cognitive domains” adversely affecting a patient’s “capacity to participate in essential self-care activities, such as managing complex medication regimens and adhering to dietary restrictions.” 

The cognitive impact is often serious, with an estimated 25 to 50 percent of stable chronic heart failure patients experiencing pre-dementia conditions of mild to moderate cognitive impairment.

This is the first study to measure the impact of a combined regimen of physical exercise and brain exercise on heart failure patients.

The main finding of the study was that participants in the combined aerobic exercise and cognitive training program had significant improvement in verbal memory at 3 months and a trend for sustained improvement at 6-months compared to exercise alone or the attention control usual care groups. In addition, the combined group also had significant improvement in the six-minute walk distance at 3 months compared to the other groups.

Since exercise and cognitive therapy were associated with improved memory in some of the people in the study further investigation the authors of the study believe that more research should be undertaken in a larger trial. The relationship between functional capacity and cognitive function also needs further study.

There is very limited evidence that exercise or cognitive training is associated with improvement of mild cognitive impairment in heart failure. This study provides evidence that a combined approach may be superior to either strategy alone for improving cognitive function in persons with stable heart failure. Large, high-quality randomized trials are needed to determine if the beneficial effects of these intervention strategies are associated with improvement in mild cognitive impairment or slows the progression to dementia.

Canadian women are relatively well-prepared financially: RBC Insurance Poll

There was a poll done in February by the Royal Bank of Canada of women with a household income of more than $60,000 a year, which is under the Canadain average household income of $73,336. Here are some hightlights from this poll.

Canadian women over 45 are relatively well-prepared for the future. The majority have a very clear idea of what they would do with a sudden lump sum of money, and only a quarter (24 percent) worry about being able to manage the money properly. A large majority (94 percent) express a prudent approach, agreeing that they would develop a strategy for making the money last. Other top responses include looking for ways to help protect the money from risks such as market volatility (92 percent) and considering investing in products that provide guaranteed income (91 percent).

However, nearly one-quarter (24%) say they wouldn’t be able to maintain their financial situations if their spouses or partners were to pass away, a figure that’s significantly higher among women 45-54 than women over the age of 65 (30% versus 14%), potentially reflecting greater financial responsibilities at midlife.

Additionally, one-third of women aren’t confident that they’ll be able to afford their preferred lifestyle during retirement.

Women appear to understand their finances and are confident but despite their strong financial awareness confidence about future security diminishes. In particular, women between 45-54 are most likely (38 percent) to express this uncertainty around the future, compared to 22 percent for women 65+. Interestingly, single women were only slightly more likely than married women (36 vs. 34 percent) to cite a lack of confidence in their ability to afford their lifestyle in retirement. Looking critically at their financial needs and having a plan for all scenarios will go a long way to maintaining that confidence right through retirement.

The majority (84 per cent) of Canadian women would like to leave an inheritance for their loved ones. Half (49 per cent) have received an inheritance themselves in the past, while a slightly smaller proportion (46 per cent) expect to receive one in the future. However, women are not depending on an inheritance to fund their retirement, with only 17 per cent agreeing that they are relying on one to help them get through their retirement years.

While Canadian women have their finances relatively well in hand, there is always room for improvement. When it comes to increasing confidence in, and preparing for their financial future, Canadian women should consider speaking to an advisor to discuss options and ensure you’re on track to meet theirlong-term financial goals. They should consider estate planning as a key component for their inancial legacy. Having the conversations early with family will help plan for a transfer of wealth.

My golf book

A guy has been very busy over the past 2 years putting his thoughts and ideas together in a book about Golf.  He is very proud of the results and in order to market the publication, he is asking friends and family to be the first to own a copy.

Here's the Table of Contents from the new book, "Winning Golf Strategies," which I believe gives the reader valuable playing tips and insider information that I've gained through my own years of experience in the game and observations of my golfing partners.

Table of Contents

Chapter 1- How to properly line up your Fourth putt.

Chapter 2 - How to hit a Nike from the rough when you hit a Titlist from the tee.

Chapter 3 - How to avoid the water when you lie 8 in a bunker.

Chapter 4 - How to get more distance off a shank.

Chapter 5 - When to give the Ranger the finger.

Chapter 6 - Using your shadow on the Greens to confuse your opponent.

Chapter 7 - When to implement Handicap Management.

Chapter 8 - Proper excuses for drinking beer before 9 a.m.

Chapter 9 - How to urinate behind a 4" x 4" post... Undetected.

Chapter 10 - How to rationalize a 6 hour round.

Chapter 11 - How to find that ball that everyone else saw go in the water.

Chapter 12 - Why your spouse doesn't care that you birdied the 5th.

Chapter 13 - How to let a Foursome play through your Twosome.

Chapter 14 - How to relax when you are hitting three off the Tee.

Chapter 15 - When to suggest major swing corrections to your opponent.

Chapter 16 - God and the meaning of the Birdie-To-Bogey Putt.

Chapter 17 - When to re-grip your Ball Retriever.

Chapter 18 - Use a strong grip on the Hand Wedge and Weak Slip on the Foot Wedge.

Chapter 19 - Why male golfers will pay $5.00 a beer from the Cart Girl and give her a $3 tip but will balk at a $3.50 Beer at the 19th Hole and stiff the Bartender.

Questions for end of life planning 2

Do your children know who your professional team is?

As you prepare the legal documents you will be choosing people that you trust and who know you, in some cases, this person may be an adult child. The children should know if you have called in other professionals who can help ease the process of settling the estate, filing insurance claims, finding and managing all the assets and more. Not only do they need to know if you have called in these professionals but they should know how to contact them if needed.

As we get older, we need more medical care, do your children know who your doctor is and how to contact the doctor? This is basic information and should be known by anyone who might be around or contacted if you should have a medical emergency.

If your children are helping you, they may need details such as a copy of your driver’s license, Social Insurance number, date of birth, place of birth, mother’s maiden name, previous addresses and access to your Medicare card and any other insurance card. Even an agent under a power of attorney or your representative under the representation agreement or your advance directive often has to provide some of this information before being allowed to take action.

Do your children know where you want to live as you age?

If the home becomes too much for you, would you prefer to move into an apartment or a place with more services, such as independent living or assisted living residence or would you like to pay for home care aides? Do you expect to move in with one of your children?

It is a good idea to consider these options and explore the choices in your area well before you need to make a decision. Otherwise, if the time comes someone will make the decision for you and it will be made in a hurry.

What do you want to happen to your remains when you die?

It is not unusual for a child to remember a casual comment a parent made years earlier about funerals, burial, or cremations and interpret that as a last wish.

Sometimes two or more children have contradictory memories about such comments. 

These memories can cause great frictions in families so write down any preferences you have and be clear about these wishes. Tell all of your children the details of this question. The children should know the answers to these questions before the need is apparent. Because you’re unlikely to be able to help with the answers when the information is needed.