Ask an Expert about Alzheimer's Disease

This is a truly baffling question, for which I can find no answer.  I have the same experience with recalling the name of a specific actor, so I hope for your sake and mine that this temporary and circumscribed amnesia is a fluke rather than a warning of more serious illness! In all seriousness, I do not think it likely that this experience is a harbinger of cognitive decline.

First, it’s important to clarify that neither donepezil (Aricept) nor any other currently available medication has been shown to prevent Alzheimer’s disease. Furthermore, donepezil is not indicated for the treatment of cognitive impairment that falls below the level of dementia. It’s not clear from the limited information that I have as to why you were prescribed phosphatidylcholine and donepezil, though your doctor may have a good reason, and it would be good for you to discuss this further with him or her.  The combination of brain atrophy on MRI and short-term memory loss is indeed worrisome, so if your doctor does not have specialized experience in treating memory disorders, this would be a good time for you to seek evaluation from someone expert in this area.

Memantine (Namenda) is indicated for the treatment of moderate to severe Alzheimer’s disease. It is believed to benefit cognitive and behavioral symptoms even at a late stage of the illness. Some evidence supports using this drug as a useful treatment for agitation such as you describe. There may come a time when it loses effectiveness, or when the progression of cognitive and behavioral symptoms of dementia alter your mother’s behavior despite whatever benefit memantine continues to provide. Fortunately, there are other behavioral and medication approaches to treating these symptoms.

You are probably aware that the only way to be certain of Alzheimer’s disease as a diagnosis is to sample tissue from the affected person’s brain and examine it microscopically.  The PET scan, which uses radioactively-labeled tracer molecules to reveal the brain’s secrets, provides strongly suggestive evidence, however. If the scan that showed reduced blood flow was an FDG PET scan, which identifies areas of low metabolism in the brain, then the diagnosis of Alzheimer’s is likely. If it was an arteriogram, looking at blood flow in the neck and head, the diagnosis is as well-established. 

If your mom has a progressive dementia, then it is possible she will become bedridden or incontinent at some point. Some medications make people sleepy or more confused and could also have those effects, and the cholinesterase inhibitors do sometimes cause diarrhea at the beginning of treatment; however, the “cognitive enhancers” such as donepezil or memantine are not generally a cause of incontinence or increased time in bed. 

It would be helpful for you talk with your mom’s doctors about their medication suggestions and your concerns.

Although there has been controversy about the possibility that general anesthesia might worsen cognitive functioning in a person with Alzheimer’s disease, there is no evidence of epidural anesthesia producing such an effect

Along with the other changes that Alzheimer’s disease brings, one very important one is diminished “resilience.” Normal cognitive functioning would allow your mother to cope with the temporary change in residence. Alzheimer’s disease, however, makes even small changes in surroundings into a more difficult and challenging adjustment.  In addition, of course, she is experiencing a change in her husband’s health, mobility, and availability. It is likely that she’ll improve once back in her usual surroundings, but sometimes a decline that begins in this way does not fully reverse. You may be able to help her by explaining repeatedly, to the extent she understands, that her husband is making progress in his recovery and that she will soon be back home.

This is so unfortunate. Your question is one that caregiving families, clinicians and scientists are continuing to ask and investigate. In an older adult, cancer surgery should not cause dementia, but sometimes surgical complications such as lack of oxygen during anesthesia can increase the likelihood of later cognitive problems. If your mom has had chemotherapy, cognitive problems may be more likely.  Evaluation by a dementia expert will be necessary if you wish to understand the relationships among her difficult disorders.

Although the therapeutic effects of galantamine and memantine (Namenda) may be modest for many patients, other patients may derive a longer and/or greater degree of benefit. The benefits may extend beyond helping memory and other cognitive functions. For some patients, the benefits include delayed deterioration of “activities of daily living,” delayed emergence of “non-cognitive behavioral symptoms,” and diminished “caregiver burden” (less time per day needed for caretaking). When addressing this concern with families, I ask them what they think the patient’s wishes would be at this stage of illness if he or she were able to make the decision. For some people, withdrawal of supportive treatment might be the appropriate choice. But keep in mind that patients taken off these medications even in a late stage might then deteriorate more quickly.