Ask an Expert about Alzheimer's Disease

Asking to “go home” is also a fairly common request for Alzheimer's disease patients. This request can mean that your mother might feel anxious or fearful of something or else she feels compelled to fulfill some obligation or task. She might, for example, be referring to a home from her youth, or perhaps her first home as an adult. She might think that she still has responsibilities to perform there, or else that it was a place she felt needed and safe.

Additionally, your mother is probably still anxious and confused by her new surroundings.  With time she can be aided in accepting the care facility as her new "home." It is wonderful that you and your family visit her frequently; continue to do so.  Marking your visits on her calendar is a great way to provide a visual reminder of the visit. Although it may be difficult at times, be patient with her. It is not uncommon for it to take several weeks and even some months for a dementia patient to fully adjust to living in a care facility.  Always remember to try to speak enthusiastically about how nice her new home is.

Perhaps the facility will allow some of your mother's personal effects (pictures, a favorite blanket, etc.) to be used in her room. The more things that are "familiar" to your mother in the facility, the sooner she will come to accept it as home. Be sure that the items are not valuable, in case they should become lost or damaged.
 
When you speak to your mother, continually reassure her that you are trying to provide the best possible care you can for her. Sometimes, patients with Alzheimer's disease become more confused and agitated in the evening (a phenomena known as “sundowning), which may be why your mother phones you upset each night. Continue to reassure your mother that no matter what, she is loved by you all and she will be cared for. Because of the nature of the disease, you will undoubtedly have to repeat this conversation many times.  After reassuring her, you can then try redirecting her attention to a more enjoyable topic.

Try not second-guess yourself about your decision.  Take consolation in knowing that your mother is now much safer in her current care home than she was living by herself in her own home. Her welfare and safety are the most important considerations, and therefore her current facility is the right place for receiving all of the care she needs now and will inevitably need in the future.

It is usually best to tell your husband the truth, or at least a simplified version of it. What you tell your husband about his condition depends on how far advanced the disease may be and his ultimate level of comprehension. If your husband is in the early stages of the disease, then you can give him more detailed information about how the disease can affect not only his memory, but also his mood and behavior.  Chances are, he probably already suspects that something may be wrong, so you are providing him with an explanation for the impairments he may have noticed.  However, if you believe that your husband is too far advanced to fully comprehend what having Alzheimer's disease means, then simply tell him that he has a memory impairment, that you are aware of the condition, and that you and the doctors are doing everything possible to care for him.

Tomatoes contain lycopene, a carotenoid antioxidant that has been shown to fight a variety of cancers in experimental protocols. Levels of lycopene, along with levels of some other antioxidant chemicals, have been shown to be depleted in the brains of people with Alzheimer's disease. The chemical form of lycopene that appears to be most useful to the human body is more plentiful in cooked than raw tomatoes, but even if tomato juice is not the richest source for usable lycopene it is nonetheless a nutritious drink that is unlikely to cause harm.

A number of preliminary studies suggest that how we eat may raise or lower our risk of developing Alzheimer's disease. Eating a diet that is high in whole grains, fruits, vegetables and that is low in sugar and fat can reduce the incidence of many chronic diseases, and researchers are continuing to study whether these dietary modifications are also applicable to Alzheimer's disease. However, the strongest research supporting these modifications has been performed in animal studies, and remains to be rigorously established in randomized and controlled human clinical trials. Further research will provide clarification on the role of diet in the prevention and/or treatment of Alzheimer's disease.

Your question suggests you may feel that you have endangered your patient by going along with the referral for ECT despite the patient's family history of Alzheimer's disease; however, there is no evidence for a harmful effect of ECT in such circumstances. There is evidence to the contrary that untreated depression may be a risk factor for dementia and ECT is a powerful treatment for depression. You will be interested also to know that some treatment centers now administer ECT to dementia patients whose aggression or agitation creates serious obstacles to care at home or in a long-term care facility. Several case studies have been reported in which symptomatic response with acceptable side effects was documented. Although ECT can interfere with short-term memory, this effect is considered temporary in dementia patients as in cognitively intact ones, and the behavioral benefits of a successful course of ECT may well outweigh the potential risks.

That said, ECT for dementia patients must be used with caution because of the possibility that cognitive impairment may reflect a medical condition that should be independently identified and treated. Appropriate informed consent (from a competent patient or an authorized health care representative) must be obtained. Adverse effects can be minimized by using modern ECT technique that emphasizes delivery of minimal current using a unilateral non-dominant hemisphere electrode placement and properly scheduled sessions.

There are so many reasons why a woman in your mother's circumstances might avoid taking a diagnostic test for Alzheimer's disease. If you start by figuring out the reasons for her reluctance, you may be able to decrease her resistance. Is she convinced that she has no cognitive symptoms? Given her family history, acknowledging the presence of symptoms would be very threatening! Could she be depressed, anxious, or medically ill in a way that is affecting her cognitive functioning? Is she demonstrating symptoms but already unable to appreciate their significance? If that's the case, asking her primary care clinician to incorporate a simple screening test such as the MiniCog or the Montreal Cognitive Assessment into her routine assessment may be a good way to increase the accuracy of her diagnosis.

Apraxia, the loss of ability to perform previously familiar actions, is characteristic of Alzheimer's disease and is increasingly common as the disease progresses. Eating and swallowing, actions so automatic for most of us, can become difficult and confusing in the late stage of Alzheimer's disease.

Determining whether your husband is hungry or full also presents problems, because even if he is able to use the words, he may not fully recognize and understand the messages his body is sending him about hunger or satiety.

The course of Alzheimer's disease is variable, with an average of about 7 years from diagnosis to death, and about 1 to 2 years often spent in the late stage. Your husband almost certainly does feel emotions and will continue to do so. Though he may not be able to tell you so in words, he may be distressed if he exhibits sadness or frustration, and comforted by a kind look, a soft touch, or a calming tone of voice.

Inflammation is thought to be an important contributor to the brain destruction in Alzheimer's disease, and some evidence has suggested that taking anti-inflammatory medications might have a protective effect against cognitive decline and dementia. The best support for this theory comes from epidemiologic studies (without support from clinical trials), so a beneficial preventive effect of anti-inflammatory medications like aspirin is not firmly established; however, a small daily dose of aspirin (used under the supervision of a physician) may have health benefits and there appears to be no evidence that it will increase the risk for Alzheimer's disease.

The clinical term you are looking for is simply Alzheimer's disease or dementia. This is what the disease does: it impairs a person's memory, robs his personality, and can make a person behave completely out of character. Many times, the only memories that are left untouched by the disease are the oldest ones, such as when the person was young. Additionally, Alzheimer's disease can affect the portions of the brain involved in social behavior and rationality/reasoning, causing the patient to act in socially inappropriate ways and/or to live in his or her own reality. This is likely why this man you speak of may think he is only 20 years old and single instead of 80 and married.