Ask an Expert about Alzheimer's Disease

Not every home environment is suitable or safe for providing care to persons with dementia, and many long-term care facilities provide attentive service; nonetheless, one often hears of Alzheimer's disease patients who have survived for years in a home environment and one might wonder how much the loving care at home contributed to the extended survival. One study that looks empirically at this question was reported by McClendon and colleagues in the Journal of Gerontology, Behavior, Psychology, and Social Sciences in 2006. This study followed 258 persons with Alzheimer's disease and their family caregivers, and found evidence supporting the idea that delayed institutionalization was associated with prolonged survival. The decision for any specific family to seek institutional care, of course, depends on many factors associated with their personal circumstances.

The "pacemaker" your dad saw is a treatment that has already helped patients with Parkinson's disease and is hoped to prove beneficial in other conditions as well. It is called Deep Brain Stimulation (DBS) and involves the delivery of pulses of electrical stimulation to deep areas of the brain. The pulses originate in a surgically implanted pacemaker and travel through thin wires implanted within the brain tissue. In a preliminary study reported in 2010 by Dr. Laxton and his colleagues, data on a small group of Alzheimer's disease patients treated with DBS suggested that electrodes implanted in the brain's memory circuit could improve both metabolic measures (glucose utilization as shown on PET scan) and clinical measures (MMSE and ADAScog). The authors encouraged further exploration of this approach.

It would be great to know the answer to this question, since nobody wants to give Alzheimer's patients medications that aren't helping them; however, there is not a great deal of scientific information to guide physicians. Studies have shown that Namenda (memantine) improves cognition and some behavioral measures in "severe" Alzheimer's disease patients, and one study published in the Journal of the American Medical Directors Association in 2004 reported that nursing home residents who discontinued Namenda showed, as a group, worse changes in cognition and mood than a comparison group who remained on Namenda. This study also reminds us that Namenda's benefits (though they may be modest) extend beyond measures of cognition.

Current diagnostic criteria for Alzheimer's disease assess rely on the presence of cognitive but not behavioral and psychological symptoms of dementia. From the standpoint of a caregiver or clinician, though, these behavioral symptoms may create more distress than loss of memory. BPSD are usually the factors that determine when a person with dementia must move into institutional care, because it is so challenging to care at home for someone who, for example, is aggressive or tends to wander. These BPSD, incidentally, do not occur only in Alzheimer's disease—they are found in other types of dementia and in conditions other than dementia—but the majority of Alzheimer's disease patients will show them at some point in the course of the illness.

I think you could look at this problem a little differently. Although current approaches do not "cure" Alzheimer's disease by reviving neurons, they have some symptom-alleviating effects. They could be considered palliative. But in the future, perhaps there will be therapies that allow stimulation of new brain cell growth or at least growth of new synaptic connections that compensate for the loss of destroyed neurons. I certainly agree with your view that current research should pay a lot of attention to prevention and early recognition as well as finding additional ways to reduce symptoms and, if possible, affect the course of the disease.

Stem cell research holds great promise for learning about the mechanisms of Alzheimer's disease, and scientists have hope that stem cells may help us learn new ways to understand and fight this terrible disease. As of yet, however, there are no stem cell therapies available and patients cannot obtain stem cells as a treatment for Alzheimer's disease. To learn more about stem cell therapies, please visit the website of the International Society for Stem Cell Research.

A steady routine and the encouraging and accepting support of familiar people helps individuals with dementia respond optimally to everyday stresses. For this reason, it's often optimal to keep a person in a familiar environment. But keep in mind that the familiar environment may not be adequately prepared to protect a patient who falls, is aggressive, or engages in risky behavior. Further, the familiar environment may lack supports and optimal stimulation. In situations where an alternative environment supplies these important protections and supports, there can be advantages to moving from a more familiar setting.

Headaches, including migraines, are reported by patients with Alzheimer's disease but whether the rate is greater than among patients who do not have this neurological disorder has not been determined. Although the accepted answer to this question is that there is no established connection between Alzheimer's and headaches, some researchers have found increased headache prevalence among people who have a particular familial Alzheimer's disease gene, called PSEN1.

Possible explanations for headaches in Alzheimer's patients include cerebral inflammation, issues with blood pressure, vision problems, and medication side effects, each of which can be treatable causes of headaches.