Ask an Expert about Alzheimer's Disease

The only proven way to slow the cognitive decline of another person with Alzheimer's is by giving the patient a cholinesterase inhibitor drug and/or memantine. These medications are FDA-approved drugs for the treatment of Alzheimer's disease and can be effective in some patients by slowing the progression of cognitive impairment. Read more about Alzheimer's disease risk reduction and prevention, and the currently approved medications.

This is a tricky question actually, and one that is often encountered in the medical research community: does a person with dementia have the capacity to provide informed consent? The simple answer is that it depends on the situation. Patients with early- to mid-stage Alzheimer's disease might still have enough of their faculties to advocate for their own care, however, this ability diminishes as the disease progresses. Therefore, it is wise while the patient is still in the early stages of the disease to draft a health care proxy appointing another individual (often a spouse or child) with the authority to make medical decisions on the part of the patient.

In general, most assisted living facilities would probably be amenable to discussing the basic care of their residents with the resident's family or an ombudsman. Depending on the situation, it may or may not be ethical (or legal) for the facility to discuss the specific care of a particular patient. This would be determined on a case by case basis.

One last thing to keep in mind is that because of the nature of Alzheimer's disease, you cannot always trust that information provided by a patient will be entirely accurate. In this case, the person with Alzheimer's disease who stated that he had not eaten may have been mistaken. Patients with Alzheimer's disease can forget that they have eaten a meal, even if the meal was just served and consumed. Patients sometimes can no longer interpret signals from their stomachs, and therefore do not know whether they are hungry or full.

As Alzheimer's disease progresses, it is not uncommon to observe patients taking more naps or sleeping for longer periods. Alzheimer's disease can affect a person's circadian rhythm (sleep/wake cycle), so a person may sleep more during the day instead of (or in addition to) at night.

Regardless of your good intentions, most people would generally not like to be accused of having dementia. First, it really depends on who the person is and your relationship with this person. If it is your spouse, close family member, or close friend, then you should be able to talk candidly with them, and to let them know that you concerned for their health. You can say that you would feel much better if they would go in for a medical check-up just to make sure everything was okay. You probably should not mention “dementia” at this point, because you do not want to unnecessarily scare or anger the person.

If the person is a co-worker or causal friend, then unless their cognitive impairment poses an immediate and real threat to their own safety or the safety of others (in which case it may be prudent to mention something to the person's supervisor, spouse, or other relative), it might best to just ask how the person is doing. You can tell the person that you noticed an odd behavior and say that you are concerned because this is not characteristic of them. It would also be helpful if you can provide a specific example of their unusual behavior. Give the person a chance to explain themselves. Sometimes stress, sleep disorders, depression, drug interactions, or other medical ailments can mimic the symptoms of dementia. Without the benefit of a physician's thorough medical and psychological evaluation, it is difficult to make a medical diagnosis of Alzheimer's disease or other dementia. Finally, if the person is not a close acquaintance, the best you might be able to do is to casually remind them to get regular medical check-ups.

You must feel frustrated and powerless being so far away from your brother and his plight. But there are several ways you can help. In your brother's area, there are a few agencies that should be able to provide information, referral services, and counseling for your brother and sister-in-law. Even though it means phoning from the UK, it might be best for you to contact the agencies initially on your brother's behalf. This way, you can speak to someone directly and hopefully get some answers to specific questions you might have. If nothing else, it will help to get the ball rolling for your brother.

The agencies are:

Appalachian Agency for Senior Citizens (AASC)
P.O. Box 765
216 College Ridge Road
Cedar Bluff, VA 24609
(276) 964-4915
1-800-656-2272 (toll free)
1-866-828-7723 (toll free)
Email: aasc@aasc.org

Virginia Department for the Aging
Website: http://www.vda.virgina.gov/
Email: aging@vda.virginia.gov
(804) 662-9333
1-800-552-3402 (toll free)

Also, since they live close to West Virginia, the following organization might also be helpful:

Appalachian Agency on Aging (AAAOA)
West Virginia Aging and Disability Resource Center
1460 Main Street
Princeton, WV 24740
1-800-473-1207 (toll free)

Additionally, you mentioned that your brother was a teacher. This must mean that he was employed somewhere. It is likely that he was friendly with someone at his place of employment, such as a former co-worker or supervisor, who might be able to at least check in on him. Perhaps they have other friends or neighbors who might be willing to lend a helping hand. What about your sister-in-law's family? Can you contact any of them for assistance? Does your brother or sister-in-law belong to any community organizations, social groups, or a church? Again, perhaps you can make some calls on your brother's behalf to ask people if they could help. Your brother may be too proud to ask for help on his own, but it will be essential that he and his wife accept some form of help in the time to come. The members of the church or other community group might be able to provide some immediate assistance or relief until such time that your brother's paperwork is filed.

It is quite common for dementia patients to sleep with open mouths, and to have their mouths agape for most of the day as well. It is nothing really to be concerned about, unless it is causing your aunt's throat to be irritated. The gum is a good idea; just make sure it is sugar-free. You can also try giving her a sugar-free candy to suck on during the day, which will help her to produce saliva as well as to be a reminder to keep her mouth closed. Additionally, if her mouth and throat become very dry as a result of this open mouth habit, you can speak to her doctor or pharmacist about using artificial saliva gel or spray.

The earliest stages of Alzheimer's disease, according to the National Institute on Aging, are characterized by brain accumulation of beta amyloid without obvious behavioral or cognitive changes. The earliest cognitive changes, detectable only on careful neuropsychological testing, may be subtle changes in memory storage. When Alzheimer's disease produces actual cognitive changes, some of the first ones are non-diagnostic (that is, they could just be signs of normal aging). The affected person feels like he or she is not remembering things as well as as they used to, but nobody else notices. The next stage in progression toward Alzheimer's, is “mild cognitive impairment,” and at that point the memory difficulties start to attract others' attention. The affected person has trouble recalling words or names, performing complex tasks, remembering what he or she has read, or planning and organizing things. This usually, but not always, progresses to Alzheimer's disease, which in its mild phase is noticeable to friends and family and even to people who did not previously know the patient. Early-stage Alzheimer's disease includes more obvious cognitive changes including forgetting significant recent events, and having greater difficulty with complex tasks such as calculating the tip in a restaurant or balancing the checkbook and paying bills. Emotional changes such as those seen in depression may also be more apparent at this stage.

Researchers and clinicians (as well as patients and their families) have become much more interested in “biomarkers” recently. Biomarkers are biologically demonstrable physical characteristics that are associated with such things as increased disease risk. In Alzheimer's disease, biomarkers are associated both with amyloid accumulation and with neuronal destruction. At this juncture, however, the ABO system of blood typing has not been found to predict risk for Alzheimer's disease.