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Monthly Archives: August 2015

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Allows for more meaningful estate planning

By Nancy Burner, Esq.

As the federal and New York State estate tax exemptions continue to increase over time, clients are less concerned with the tax consequences of their estates and more concerned with protecting the beneficiaries from outside invaders, like divorcing spouses, creditors and long term care expenses.

As a result, the wills and trusts we draft today are geared toward protecting those heirs. It may be time to review your estate plan in view of the changes in the estate tax laws and the general evolution of trust law itself.

A major shift is in how we transfer assets to beneficiaries. Many clients in the past would create trusts that distributed assets to children at specific time intervals, i.e. upon turning the age of 25, 30, and 35. While this is still an option, it does not provide the maximum level of protection for the beneficiary.

By creating trusts that we refer to as “descendants’ trusts,” the beneficiary can have creditor protection, protection from divorcing spouses, Medicaid protection and protection against estate taxes when the assets are passed on to the beneficiary’s heirs.

This trust can be drafted with different options. The beneficiary can be their own trustee, co-trustee at a stated age and then their own trustee at a later age, or have a co-trustee indefinitely. The beneficiary can be entitled to the income of the trust and can distribute principal to themselves for health, education, maintenance and support. If the beneficiary needs principal for any other reason, they can appoint a friendly, independent trustee to authorize principal distributions. The trust can state where the assets will go on the death of the beneficiary without the beneficiary having discretion over the disposition at their own death.

Alternatively, the beneficiary can have a “limited power of appointment,” which allows them to designate where the trust assets will go upon their death. The limited power of appointment will state that the beneficiary can designate in a will, trust or separate instrument, the group of people that the assets can be given to upon their death.

For example, a father creates a trust and states that upon his death the assets are put into two descendants’ trusts, one for each of his children. The trust can state that each child has the power to appoint the assets to their spouses, descendants, and/or charities. In certain circumstances, a larger group of persons may be designated as the group to which the assets can be appointed.

Another change clients are making in their estate plans relates to the trust structure when leaving assets to a spouse. When the estate tax exemption for New York State was $1 million, a typical middle class couple on Long Island could easily have a taxable estate because of the high value of their home.

For these people, it was extremely important to create a credit shelter or bypass trusts to save estate taxes at the death of the second spouse. Luckily, with the increasing exemption at $3,125,000 in 2015 and $4,187,500 in 2016, this is less of a concern, but many clients have documents from before 2014 that may be obsolete.

Furthermore, the will or trust can add “trigger” supplemental needs trusts that can protect the beneficiary if he or she needs long term care. With many of my clients living well into their 90s, their children may be in their 60s and 70s when the parent dies. The may have done their own asset protection planning only to inherit more assets from a parent that are not protected. By creating descendants’ trusts in their documents, this problem can easily be solved.

Nancy Burner, Esq. has practiced elder law and estate planning for 25 years.

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By Rachel Siford & Heidi Sutton

Thirteen-year-old Jessica Finger has loved dolphins all her life. Now, in celebration of International Dolphin Day, which is held every year in September, she is giving back by organizing a unique fundraising event on Sunday, Aug. 30, to help them. Titled Dogs for Dolphins, the event is part of her Bat Mitzvah community service project.

Jessica Finger. Photo from Beth Finger
Jessica Finger. Photo from Beth Finger

It is customary for a community service project to go hand in hand with a Bat Mitzvah, along with Hebrew school and learning about the Jewish faith. Her Bat Mitzvah is scheduled for October.

Jessica has a very strong stance on anti-captivity of these beautiful sea creatures. “I’ve been passionate about helping dolphins and whales since I was really little,” said Jessica. “I started to like them because of SeaWorld, but then I realized the truth and now I am an activist against [SeaWorld].”

“[Dolphins] are just more intelligent than other mammals … they live with their families for their entire lives and they are very interesting,” said Jessica, adding that killer whales (orcas) have a special place in her heart. Her favorite book is “Behind the Dolphin Smile” by former dolphin trainer Richard O’Barry.

Her mother Beth said that Jessica became even more passionate about saving dolphins after watching “The Cove.” The 2009 documentary shows O’Barry exposing Japan’s massive dolphin slaughter that takes place in the town of Taiji by local fisherman annually from September through April. The group Whale and Dolphin Conservation has stated that, since 2000, more than 18,000 dolphins from seven different species have been either killed or taken into captivity during the Taiji hunt.

According to the teenager, “it changed my life ever since. I now use Instagram to be an activist for dolphins in captivity and for giving updates about the infamous ‘Cove’ in Japan,” she said.

Barry went on to found The Dolphin Project, which aims to stop the murder and exploitation of dolphins around the world. Jessica found out about this organization about a year ago through social media and decided to raise money to support this noble cause. With a goal of $750, she has already raised $336.

Jessica and her mother completed a six-hour training course at the Long Island Aquarium this summer and now volunteer at the Riverhead tourist attraction where they interact with guests and provide them with interesting facts about the animals there. Jessica’s favorite job is working at the touch tank where visitors can have a hands-on encounter with sea stars, clams, whelks, hermit crabs and horseshoe crabs.

“I agreed to volunteer with Jessica since it’s something that she desperately wanted. I have to admit that I am enjoying it very much and look forward to it as much as she does. I am constantly amazed at how knowledgeable she is about marine life. We are excited to volunteer at a seal release on Monday, Aug. 31, at Cedar Beach in Mt. Sinai,” said her mother, adding “It’s also a great way for us to have some meaningful mother-daughter time.” Members of the Riverhead Foundation for Marine Research and Preservation will be at the event to speak about how they rehabilitate marine life.

A true animal lover, Jessica lives in Nesconset with her parents, two younger brothers, a dog named Summer, two rabbits, three tortoises, a frog and tropical fish. Jessica said her goal in life is to “be either a marine biologist or a member of The Dolphin Project.”

“I am very proud of Jessica for her compassion for all animals. She has deep integrity at such a young age. Her love for animals led her to become a vegetarian when she was only eight years old — she will not wear leather or even enjoy marshmallows and S’mores with her friends because there is gelatin [an animal product] in them,” said Jessica’s mom. Her stance has “inspired several of her friends to become vegetarians too,” she added.

“It is appropriate that the occasion of her Bat Mitzvah, when she takes on the role of being a responsible young adult, was the impetus for Jessica to bring the community together to help make the world a better place. In Judaism, we call that Tikkun Olam, and I can’t think of a better way for Jessica to launch this next chapter of her life as a Bat Mitzvah,” said her mother proudly.

On Aug. 30, from 11 a.m. to 1 p.m., Jessica invites the community to bring their dogs along with friends and family to the Baiting Hollow Farm Vineyard, 2114 Sound Ave., Calverton, for a walk through the trails of the vineyard to support a great cause.

The walk will be followed by lunch, a pie tasting, activities for kids and dogs, crafts and wine. Patrons will be able to decorate bandanas for their dogs and play games. Massage gift certificates, gift cards to restaurants and cooking classes at Sur la Table will be raffled off during the afternoon.

The event is sponsored by Animal Health and Wellness Veterinary Care in Setauket, Pet Supplies Plus and Long Island Iced Tea, and patrons can expect an endless supply of free ice tea and pet treats.

There is a $10 per person suggested donation at the door (includes lunch) with 100 percent of the proceeds going to support The Dolphin Project (www.dolphinproject.net). There is no rain date. Advance registration is available by  visiting www.crowdrise.com/dogsfordolphins. For more information, please call 917-414-4526.

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“Take me out to the ballpark” was the theme for all of last week, as I took my youngest grandchild on what has become a family tradition. Traditions can be great fun, and this one started when my first grandchild was 11 years old, which is to say about nine years ago. I signed us up then for the Elderhostel intergenerational touring program. Elderhostel, a not-for-profit tour company with an educational bent, that has since changed its name to Road Scholar, began offering specialized programs of usually one week’s duration for a grandparent accompanied by a grandchild in addition to their many other tours. That sounded like a good way to get to know my grandchild without his parents and sibling present, even as we might both learn something new, and we attended the NASA offering in Houston. The experience was totally satisfying and the stage was set for the remaining grandchildren, hence the trip last week.

Now to go on this particular tour, called Baseball: From Little League to the Hall of Fame With Your Grandchild, it helps if you like baseball — a lot — which I do, because it’s pretty much total immersion. We drove to Lock Haven University, the program provider, which is located in rural western Pennsylvania. That was the starting point, and when we arrived we discovered that there were eight boys and 10 grandparents enrolled in the program. The asymmetry was due to the fact that both grandparents accompanied a couple of the children. The families came from a broad geographic cross section of the country: California, Wisconsin, Vermont, North Carolina and Florida were represented, as well as another Long Island family from Port Jefferson.

The grandchildren started with a rigorous baseball clinic led by the Lock Haven baseball coach, and over the ensuing days the grandparents and grandchildren came to enjoy each other. Although the ages of the children ranged from 10 to 14, and their heights were dramatically different, the coach was readily able to integrate them into a display of fielding, throwing and hitting. The kids proved to be already accomplished, and the grandparents — who were lined up on benches in the shade of the dugout like birds on a wire — had much to cheer.

As you would imagine, we saw a number of baseball games, from major league play to the minors, to Little League. We were given an insider tour of the new and beautiful Phillies ballpark, then watched as the home team beat the Toronto Blue Jays, a particularly sweet victory for those of us who root for the Yankees since they are in a tight division race with the Toronto team. The Blue Jays loss narrowly kept the Yankees in first place.

We also watched the Reading Fightin Phils, a farm team of the Phillies organization, play the Auburn Doubledays in Reading, Pa.; and, on another night, the Williamsport Crosscutters take on the Auburn team. We even got as far north as Cooperstown, where we spent an afternoon in the National Baseball Hall of Fame. We did all this traveling by bus, leaving our cars behind in Lock Haven. The hours in the bus were made more palatable by the beauty of the countryside, largely undeveloped long stretches of lush, green forests alternating with occasional farms, silos and corrals. There were also several movies shown on the bus — with baseball as their unifying theme, of course. I must say, they were good ones, including “A League of Their Own” and the Kevin Costner award-winner, “Field of Dreams.”

The tour ended at the Little League Baseball World Series in Williamsport, Pa., with grandparents watching play from perches on the steep hills or seated in the shaded partial stadium; and grandchildren sliding down the hills on flattened cardboard boxes in between innings. That evening, Johnny Wilson Sr., a former Negro League baseball player and also member of the Harlem Globetrotters, spoke to us about his experiences in professional sports.

At age 88 he has seen profound changes in sports throughout his career. A trim and elegant man, he dispassionately shared some of the prejudices in his early years that blocked his advancement and undoubtedly broke his heart along the way. But his stories, like our baseball tour, had a happy end.

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Former President Jimmy Carter’s announcement last week that he had four spots of cancer on his brain made me think of Wallace Hartley. Engaged to Maria Robinson, Hartley spent a week with his fiancée in Yorkshire, England before he brought his violin to lead the orchestra on the maiden voyage of the Titanic in 1912.

The 33-year-old violinist played music as the enormous ship floundered and disappeared with more than 1,500 other people into the frozen waters of the Atlantic Ocean.

After Hartley’s body was recovered, 40,000 people reportedly lined the route of his procession, while more than 1,000 people attended his funeral.

What is it about Hartley that captured the imagination of the people in England? Is it that he offered something resembling normalcy and decency in the face of certain death? Is it that he didn’t panic, dive overboard or do whatever he could to save himself? Maybe.

Or perhaps it’s that his swan song was so beautiful that it might have offered something remarkable, memorable and peaceful that night to two groups of people: those safely at a distance in lifeboats and the ones confronting the final moments of their mortality.

Last week, Carter, who is 90 years old, offered a picture of calm as he grinned, answered questions and remained positive throughout a public discussion of his health.

I’ve often heard people imagine what it is that makes humans different from other animals. At one point, a discussion centered around our use of tools. Chimpanzees, however, remove leaves and branches, jamming sticks — or in this case their own version of tools — into a termite mound and eating the insects attached to those branches.

Maybe we’re different, some have argued, because we use language. Given the extensive sounds of songbirds on Long Island, the range of noises dogs make when we return home after our bosses bark incessantly at us, or the calls of whales over hundreds of miles of ocean to each other, it’s hard to believe we hold an exclusive on language.

Among other things, maybe we’re different because we can see through time. We can imagine the Big Bang 13.7 billion years ago, we can picture the age of the dinosaurs and we can work toward a 5-, 10- or even 20-year plan in our lives.

We can also salute the life of someone we knew. Long ago, when my son was 4, we passed a chipmunk roadkill. He asked whether the members of that chipmunk’s family missed him.

Despite the familiarity of routine in our lives, we recognize the uncertainty of each day, whether we have the good fortune to live as long as Carter or the misfortune to see a sudden end, the way Hartley did. In those final moments, if we get them, we might have an opportunity to offer a memorable swan song, tipping our caps to others who are still here, grinning the way Carter did, at a life well lived, at friends, at family and at memories that will outlive us.

More than 100 years later, Hartley’s name is immortalized at his grave and through the Internet, a tool for communicating developed long after he played his last note and offered what legend has it were among his final words: “Gentlemen, I bid you farewell.”

Carter has no idea how many notes he still has left to play with his diplomacy and his efforts to construct homes. In this press conference, however, he shared a broad smile and a reassuring tone, ready perhaps for the moment — whenever it comes — to bid us all a peaceful farewell.

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Stephen Ruth mugshot from the SCPD

Police arrested a Centereach man on Tuesday afternoon who they say used a pole to turn red light cameras away from the road and potential violators.

According to the Suffolk County Police Department, the suspect used an expandable pole to tamper with the cameras, pushing the lenses toward the sky. Officers from the SCPD’s 6th Precinct Crime Section received anonymous tips regarding a video post on social media that allegedly shows 42-year-old Stephen Ruth tampering with several of the cameras in Ronkonkoma, including one on Ocean Avenue at the Long Island Expressway’s south service road on both Aug. 21 and Aug. 24. Shortly before being arrested on Tuesday afternoon, he also allegedly tampered with two other cameras on that same service road, at the intersection with Hawkins Avenue.

After an investigation, officers arrested Ruth at his home on Stewart Circle.

He was charged with four counts of third-degree criminal tampering and four counts of second-degree obstruction of governmental administration.

Attorney information for Ruth was not immediately available on Wednesday.

The red light cameras, which are maintained by Baltimore-based Affiliated Computer Services Incorporated, take photographs at busy intersections throughout Suffolk County, recording license plates of vehicles whose drivers run through a red light or do not come to a complete stop before making a right turn on a red signal. The company reviews the photos snapped — and gets final approval from the county — and for each confirmed violation, the registered owner of the vehicle receives a $50 traffic citation.

Suffolk’s red light camera program began in summer 2010, and signs alert approaching drivers at every intersection where there is a camera.

Unlike other moving violations, red light camera violations do not add points to a driver’s license, as the cameras only record rear license plates and cannot confirm the driver of a violating vehicle.

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From left, Aaron Dalla Villa, Sean King and Jay William Thomas in a scene from ‘Orphans.’ Photo by Jacob Hollander

By Charles J. Morgan

The three-person drama “Orphans” officially opened at the Conklin Barn in Huntington last week kicking off a 12-performance run.

It is no wonder that stars like Alec Baldwin, William Devane and Ned Beatty have played a part in the past on Broadway in this powerful, dynamic effort. Playwright Lyle Kessler has written an interlocking, emotion-laden, compelling drama about two orphaned brothers living in North Philly; one, Treat, a slick domineering “Mack the Knife” type played to the hilt by Aaron Dalla Villa; the other, Philip, a mentally challenged younger brother who manages to maintain a tenuous grip on reality, handled skillfully and deftly by Jay William Thomas. Treat is convinced that his criminal lifestyle is morally acceptable since it is all for the benefit of his meek, needy and obedient brother.

Both actors discharged their characterizations brilliantly. Kessler has painted the emotional dynamism here with the precision of Seurat’s pointillism, perhaps with an admixture of Van Gogh’s intensity. Dalla Villa and Thomas display this with character intensity, revealing each to be skillful actors with an explosive stage presence and role interpretation of the highest magnitude.

Then on to the 18-inch-high stage platform of the Conklin Barn enters Sean King as Harold. He is drunk and has been kidnapped by Treat who discovers that Harold has a load of stocks, bonds and cash in his briefcase as well as on his person. Treat ropes him to a chair and, foolishly, leaves Philip in charge of him as he goes out to make outlandish “ransom” demands.

The great dramatic change comes when Harold frees himself and becomes the salient character. Was he a mob boss? A crooked businessman? Actually, he provides intellectual and emotional help to Philip, putting him on the road to extra-mental reality.

Treat is enraged on returning, but Harold mollifies him with a promise of a job as his bodyguard at an enormous salary. At this juncture the audience is beginning to realize that King’s portrayal of Harold is something larger than life. Harold is “The Other.” He dispenses moral and ethical advice that begins to give some concrete meaning to the lives and actions of Treat and Philip. King’s consistent playing of this role is startlingly understated, which gives it far more impact than if there had been added bombast — a temptation to a lesser skilled actor.

The final scene in this two-act production occurs in a very heart-rending denouement redolent of a Renaissance triptych.

Direction was by the multitalented Jim Bonney. Any director confronted by a fast moving three-actor property has issues with blocking. Bonney overcame this problem with the fastest-paced blocking your scribe has seen in a long time. He used karate, a fist fight, wrestling and logical positioning that was keenly correct. Bonney’s skills were challenged, but he showed his directorial métier so admirably that he came up with a tightly controlled, expressive result.

Is there a philosophy in “Orphans”? Yes. But it is not a transcendent one … more of a purely human one. Yet the humanity of Harold is so overwhelming, despite his lifestyle that it penetrates the façade of “goodness” between the brothers. It is tragedy, yet its human dimension provides an element of hope. Keep in mind that Renaissance triptych.

Bonney/King Productions will present “Orphans” at the Conklin Barn, 2 High St., Huntington, through Sept. 5. Meet the playwright Lyle Kessler and join him for a Q-and-A after Sept. 4th’s performance. Tickets are $25. For more information, call 631-484-7335 or visit www.brownpapertickets.com.

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By Elof Carlson

William Bateson (1861-1926) grew up in an academic home and attended Cambridge University where he took an interest in embryology. He went to Johns Hopkins University to learn the new experimental approaches and insights into the cellular events leading to embryo formation. While there, he was inspired by William Keith Brooks who urged him to study heredity if he wanted to contribute to a field in need of scientific rigor.

When he returned to England, Bateson studied variations and identified two types that were unusual. He called one group homeotic changes because they put organs in the wrong place, such as a fly’s leg emerging from an eye. The other group he called meristic variations, which duplicated parts, like a child born with six fingers on each hand and foot. Both meristic and homeotic mutations were considered pathological by most breeders and physicians, but Bateson believed they could be the raw material for new organ systems or more dramatic origins of new species. He published the results of this work in 1894, and it made him regarded as an enemy by British Darwinists who favored all mutational change as gradual and never sudden.

In 1900 Bateson read Mendel’s papers and was immediately won over to his approach. He began studying mutations in plants and animals. He also gave a name (in 1906) to this new field and called it genetics. Bateson used the symbols P1, F1 and F2 for the generations of a cross. He used the terms homozygous and heterozygous for the genotype of the individuals in a cross. He described the mutant and normal states of hereditary units as alleles.

Bateson discovered blending types of inheritance and genetic interaction in which two or more nonallelic genes could jointly affect a trait. He even found (but did not correctly interpret) non-Mendelian recombination of genes. In this he was scooped by Thomas Hunt Morgan and his students. Morgan was also a student of Brooks at Johns Hopkins and, like Bateson, originally skeptical of Darwinian subtle variations as the basis for all of evolution. But Morgan added cytology to his studies and related the hereditary units (called genes after 1909) to the chromosomes on which they resided.

Bateson felt chromosomes had little to do with genetic phenomena. He was wrong and it was not until the 1920s that he grudgingly admitted Morgan’s fly lab had advanced the field of genetics he named.

Bateson’s work led to an explosion of interest in the field of genetics, and, while he was trapped by his views of the time, younger scientists had no difficulty adding genes to chromosomes, mapping them and accounting for the transmission of traits through their behavior during cell division and germ cell production.

In 1910 Bateson was probably the most famous geneticist in the world. By 1920 he was fading, and after his death in 1926, he was largely forgotten to all but historians of science.

That is not uncommon in the history of science. Science changes faster than any individual scientist can change views in a lifetime. Despite the loss of prestige, it is fitting to honor the memory of the person who named the field of genetics and whose battles to make Mendelism its core succeeded over the prevailing views of heredity at the end of the nineteenth century.

Elof Axel Carlson is a distinguished teaching professor emeritus in the Department of Biochemistry and Cell Biology at Stony Brook University.

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From left to right, Stephanie Belli’s sister Diana and mother Carol receive their copy of the book with Rabbi Cohen of Chabad at Stony Brook. Photo from Chabad at Stony Brook

Four hundred acts of kindness turned out to be an underestimate.

It has been one month since a horrific Cutchogue car crash killed four North Shore women, and Chabad at Stony Brook set out to assemble a book of kind acts to show how good could come out of tragedy. But by the time that book was finished last week, it had grown into a much bigger list.

Smithtown’s Brittney Schulman, 23, and Lauren Baruch, 24, as well as Stephanie Belli, 23, of Kings Park, and Amy Grabina, 23, of Commack were riding in a limousine in the middle of a weekend wine tour on the eastern part of the Island when Steven Romeo, 55, T-boned their vehicle as it made a risky U-turn, killing the girls and injuring five others.

After the crash, Romeo was arraigned at Eastern Long Island Hospital and charged with driving while intoxicated. He was initially ordered held in lieu of $500,000 cash bail, or $1 million bond, but that bail was reduced to $50,000 cash or $100,000 bond. Suffolk County District Attorney Tom Spota said Romeo had recorded a blood alcohol content of .066 percent — below the legal limit of .08 — when he was tested roughly one hour after the crash. The DWI charge, however, was not dropped, Spota said. No additional charges were filed against Romeo as the investigation continued.

Romeo’s court date, which was originally set for last week, was adjourned to Sept. 18.

The tragedy sent shockwaves through the greater North Shore community, and Chabad at Stony Brook called on everyone to help.

“People came out in big numbers to post all these heartfelt things they were going to do,” said Rabbi Shalom Ber Cohen of Chabad at Stony Brook, who helped launch the project in the wake of the tragic crash. “We’ve always encouraged to respond to darkness with light, and to evil with good.”

The group launched a Facebook group called “Goodness & Kindness x 400 for our girls,” and acquired thousands of page views in a matter of days, Cohen said. The goal, he said, was to remember the lives of those lost by compiling a book of names and acts of goodness committed in their honor, to show victims’ families that they were not alone in their darkest hour.

“We felt we were swarming in death,” Cohen said. “This was an act of goodness and kindness to bring more goodness to the world. While we can’t bring the girls back, when the community comes back and shows we are there, it does bring some kind of goodness.”

Good deeds included anything from committing to donate to worthy causes to something as simple as paying for succeeding cars in a Starbucks drive-thru.

Cohen, along with wife Chanie Cohen, a Chabad program coordinator, as well as Rabbi Chaim Grossbaum, Rabbi Motti Grossbaum and the rest of his staff, delivered those books to the victims’ families over the last week and said they helped everyone move forward in a time of great loss.

Diana Belli, sister of Stephanie Belli, took to the “Goodness & Kindness” Facebook page to express her gratitude.

“Thank you so much! With love, my entire family,” she wrote on the page. “This means a lot to us.”

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I think most of us can agree that we want to age as gracefully as possible. But, what does this mean? While we may want to avoid physical ailments, such as achy joints and musculoskeletal pain, cognitive decline seems to be one of the scarier prospects as we age. The one organ in our body that we can’t yet transplant is the brain, so we really need to keep it in the best shape possible. We will all experience some form of age-related cognitive decline. But what about more significant changes in brain function?

The prevalence of mild cognitive impairment is hard to quantify, but roughly 16 to 22 percent of us will experience it (1). The reason for the range is that it is difficult to define but is thought of as a disorder that is between normal cognition and dementia. However, it is not a normal stage of aging. Mild cognitive impairment may lead to dementia, which is defined as affecting the memory and also at least one other part of the brain, such as executive functioning (2). The most common form is Alzheimer’s disease.

Who is at highest risk for decline from mild cognitive impairment and dementia? It turns out that this is a potential question of gender. Of those with mild cognitive impairment, women tend to worsen at an almost two times faster rate than men (3). However, researchers were baffled as to why.

There are preventions and treatments that may alter these different disorders that affect our mental functioning.

There may also be tests to determine whether you are at increased risk for dementia. These range from a short mental exam in the physician’s office to a saliva test that measures cortisol levels, the stress hormone. Higher levels of cortisol at night than normal were associated with significantly less brain volume and reductions in cognitive function in participants who did not have signs of impairment yet (4).

As “location, location, location” is important to real estate, it seems that lifestyle modifications including exercise, diet and overall brain fitness may be important to cognitive functioning.

Where do drugs fit in terms of treating dementia? The main class of drugs, cholinesterase inhibitors, seems to disappoint and also appears to have significant side effects.

Let’s look at the evidence.

Side effects of medication

Unfortunately, we do not have medication that is a silver bullet to successful outcomes in dementia. The mainstay medications are among a class referred to as anti-cholinesterase inhibitors, drugs that have a mild effect on dementia. These drugs include Aricept (donepezil), Exelon (rivastigmine) and Razadyne (galantamine). In a recent study, results showed that anti-cholinesterase inhibitors caused significant weight loss (5). Compared to those not on anti-cholinesterase inhibitors, there was a 23 percent increased risk of at least 10 pounds or more in unintentional weight loss over 12 months. There were more than 6,000 patients who were 65 years and older involved in the VA health systems retrospective study. This means that approximately 1 in 21 patients treated with these drugs may experience harmful weight loss over one year. Talk to your doctor about the risks and benefits of this drug class.

Exercise, exercise, exercise

Why? There are three recent studies showing exercise’s beneficial impact on cognitive functioning. Exercise may play a role in not just prevention but also in treatment.

Two of the studies were presented at the Alzheimer’s Association International Conference. In one, results show that exercise actually reduced tau proteins in patients over the age of 70 with prediabetes and amnestic mild cognitive impairment (6). These are patients considered at very high risk for Alzheimer’s disease.

The patients who saw a benefit did moderate to high intensity aerobic exercise compared to those who did stretching. The key to success in patients who are older (55 to 89 years) was to gradually increase the intensity and duration of exercise over a six-week period until 30 out of 45 minutes were spent at 75 to 85 percent of their maximum heart rate. The frequency of exercise was four days a week. The exercise increased blood flow to areas of the brain typically affected by Alzheimer’s disease.

In another study, results show that walking 40 minutes in addition to warm-up and cool-down periods, totaling one hour of exercise three times a week, could improve cognition in those with vascular cognitive impairment (VCI), another form of dementia (7). This population was composed of 56- to 96-year-olds with mild VCI. The duration of the study was six months.

A third exercise study was a randomized controlled trial (RCT), the gold standard of studies. In this study, participants trained to moderate to intensive aerobic exercise levels, 70 to 80 percent of maximum heart rate (8). The subgroup population that maintained at least an 80 percent adherence to the exercise regimen saw a significant positive change in the Symbol Digit Modalities Test (SDMT), a test used for attention and mental speed, compared to the control. However, the primary end point did not reach statistical significance. There was also an improvement in neuropsychiatric symptoms in the treatment group. These patients trained over a four-month period and had mild to moderate Alzheimer’s disease at baseline. This is the first study to indicate that exercise could have an impact on those with Alzheimer’s disease. The median age was 72 for the treatment group.

The role of diet

In a study, those who had the greatest adherence (top tertile) to the MIND diet were cognitively 7.5 years younger compared to those who had the least adherence (bottom tertile) (9). The MIND diet is a modified combination of the Mediterranean diet and the dietary approach to stop hypertension (DASH) diet. This was a prospective (forward-looking) observational study over a 4.7-year period involving almost 1,000 patients with a mean age of 81 years.

Lifestyle modifications

So far, we have seen the potential benefits of diet and exercise as separate entities. But what if we brought numerous components of lifestyle modifications together? In the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) study, results show that a multidisciplinary approach to lifestyle modifications potentially slowed cognitive decline in a healthy older population (10). The treatment arm participants had a 25 percent improvement in cognitive scores, compared to the control group given health advice only. The lifestyle modifications in the treatment arm included diet, exercise, brain training and management of vascular risk factors. This was a large, 1,260-participant, RCT involving 60- to 70-year-olds over a two-year duration. The population, though healthy, was at risk for mild cognitive impairment.

Testing for risk

In a study involving the Memory Binding Test (MBT), those who did not perform well were at a significantly greater risk of amnestic mild cognitive impairment and dementia (11). This is a test that can be performed in a physician’s office in about 10 minutes. The test involves associative binding between two word lists. Those who do poorly on the test are at 2.5 times increased risk of amnestic mild cognitive impairment and at a greater risk of dementia. The test had good durability with up to a decade of follow-up.

Thus, lifestyle modifications, with or without medications may have powerful effects in preventing and potentially treating mild cognitive decline and dementia.

References:

(1) Lancet. 1997;349(9068):1793; Ann Intern Med. 2008;148(6):427. (2) uptodate.com. (3) AAIC 2015. Posters P4-108. (4) Neurology. Online 2015 Aug 19. (5) J Am Geriatr Soc. 2015;63(8):1512-1518. (6) AAIC 2015. Oral presentations 0504-05. (7) AAIC 2015. Oral presentations 05-04-04. (8) EAN 2015. Abstract O310. (9) Alzheimers Dement. 2015 Jun 15. (10) Lancet. 2015 Jun 6;385(9984):2255-2263. (11) AAIC 2015. Abstract O3-10-04.

Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, go to the website www.medicalcompassmd.com or consult your personal physician.

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Cops charge Eddie Schmidt with grand, petit larceny as association continues search for missing finances

Former Poquott civic President Eddie Schmidt goes over civic matters over the summer. File photo by Barbara Donlon

Former Poquott Village Trustee Eddie Schmidt, who was accused of stealing more than $23,000 from the civic association while the 22-year-old was the group’s president, was arrested and charged with grand and petit larcenies last week.

Police said Schmidt, who was arrested at 10:45 a.m. on Aug. 17 at his home on Birchwood Avenue, was charged with two counts of petit larceny and one count of grand larceny for incidents of theft that occurred between September 2013 and May 2014, according to a police spokeswoman. She said Schmidt took cash from the Poquott Civic Association.

Tad Scharfenberg, an attorney representing Schmidt, called the situation “outrageous,” and said “from what I’ve seen he’s actually done nothing wrong.” In a phone interview on Tuesday, Scharfenberg defended his client and said he didn’t steal any money.

“They’re just unhappy with the way it was spent.”

Scharfenberg said Schmidt didn’t spend any of the money on himself. Asked what he spent the money on, Schmidt’s attorney said they’re analyzing that now, and he called it a “situation where I don’t think he did a great job of record keeping.”

“This is a really good kid,” Scharfenberg said. “College kid, working hard. They’re trying to blow him up and it’s not right.”

The arrest marks a milestone in a saga that had gripped the village earlier this year, when civic officials alleged he took more than $23,000 while he was the president of the Poquott Civic Association.

Officials had claimed that while president, Schmidt used money raised at civic events to purchase things unrelated to civic expenses, like gasoline, Vineyard Vines clothing and dining at gourmet restaurants.

Schmidt resigned as president of the group last September.

Earlier this year, Schmidt fired back against the accusations in an email, breaking his silence since the allegations arose late last year. He called the claims rumors.

“The silence was a courtesy as I thought the present Board was genuinely working towards a mutual agreement between us to benefit the community. Unfortunately, the board was not genuine in its dealings, and has acted contrary to resolution,” Schmidt said in the letter. “I am writing this letter now to explain the situation, as I have genuine concerns regarding the presentation of the information by the Board, and by the climate of rumor that has spread throughout our village.”

In that letter, he spoke about the events he helped bring forward as president of the civic, despite carrying a hefty workload while attending college at 19 years old.

“I did my best to work towards common ground while rumors became widespread, and incorrect information and damaging assumptions were presented.”

In March, Poquott Civic Association officials spoke publicly about a potential settlement between Schmidt and the board for $15,000. President Carol Pesek said at the time that the settlement offer was for $15,000 — $5,000 less than the money originally demanded late last year — and also included a controversial confidentiality clause that would forbid the board from speaking of the matter. There was also a nondisclosure clause that would forbid it from letting the community know where the money came from, and an agreement that Schmidt would not be prosecuted, the civic board said. But civic officials couldn’t get past the confidentiality clause.

It’s not immediately clear what happened to that settlement offer.

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