Ask an Expert about Alzheimer's Disease

Researchers believe that oxidative damage and inflammation contribute importantly to the progression of Alzheimer's disease. This has led to the use of various natural substances and medications with antioxidant and anti-inflammatory properties in research studies. Among the polyphenols that have been studied, turmeric, curcumin and grape seed extract have all been in the news recently. For example, in 2010 researchers at the Mount Sinai School of Medicine published a study of grape-seed polyphenol extract (GSPE) in the Journal of Alzheimer's Disease. They reported that mice engineered to show features of Alzheimer's disease showed reduced formation of neurofibrillary tangles (tau protein pathological changes) when they were given oral GPSE. A more recent publication by the same research group showed that GSPE reduced a specific form of beta-amyloid protein in a mouse model of Alzheimer's disease. It does not appear that GSPE has yet been studied in humans with Alzheimer's disease.

Repetition is probably the best method to get someone, even a person having Alzheimer's disease, to remember something. The more often someone is exposed to something, the more likely they are to remember it. However, don't limit yourself to simply repeatedly telling your mother to use a walker. Use other means of reminding her such as written memos (post-it notes on places you are sure she will see), or pictures or drawings showing her using the walker.

It is also possible that your mother does not use the walker because it is uncomfortable or awkward for her, so be sure to check that it is properly fitted for her size and that it has comfortable grips. It might also be that your mother simply is embarrassed that she has to use a walker; her pride might be what is impeding her from using it, not her memory. Whether or not this is the case, be positive when you remind her—don't berate or belittle her for not using her walker. Keep telling her that you are concerned for her safety, and that you would feel much better knowing that she is using her walker.

Unfortunately, there really is no way to reason with Alzheimer's patients because the rational part of their mind is impaired. As such, the best way to deal with an argumentative patient is to not argue back as much as is realistically possible, and then to placate him (agree with him or give him what he wants even if your first instinct is to say “no” or “you're wrong), change the subject to something less contentious, or distract him with a new activity (ideally something he enjoys). Importantly, try to stay calm and positive when dealing with your father-in-law (easier said than done, yes). Oftentimes, it is not the subject matter that is upsetting to a patient, but the fact that he cannot understand what you are telling them. He therefore becomes frustrated and may feel that “no one understands what he is saying” when in fact the converse is true.

Therefore, when speaking to him, make sure you are in the same room as him and try to look directly at him when talking. Always keep directions clear and simple, and explain yourself even when you think something is perfectly clear. For example, if your father-in-law becomes upset that you are turning the lights off before bedtime, you simply say, “I am turning off the lights now. It is time for bed. We always turn off the lights at bedtime.”

You might also try to determine if there are certain situations that trigger his outbursts against your children. Children by nature can be loud and unpredictable, especially young children, and this can agitate persons with dementia or else cause them to become anxious. In an active household, even normal background noise and commotion from various sources (TV, radio, lawn equipment, street traffic, household appliances, pets, etc.) can agitate a person with Alzheimer's disease. Add to this mix noisy, energetic children and you can see why it might make a dementia patient snap.

There is no way to stop your kids from making noise or playing in their own home (nor should you), but as much as they can comprehend, you can encourage them to do their lively activities outside or else in another part of the house from your father-in-law. However, this does not mean that you should totally separate your children from their grandfather. All of them can benefit from spending time together, so long as the activity is structured. For example, try to encourage quiet activities that both your children and father-in-law are capable of participating. Reading, looking at photo albums (or creating a new photo album), simple gardening (or for you kids, just digging in the dirt or sand), taking walks, making cookies, or other simple crafts (think finger painting, drawing) can be enjoyable for both parties.

Remember to keep the activity simple and short. Your father-in-law, for instance, may only be able to tolerate 10 minutes of one-on-one time with your kids (or vice versa). So try to have a defined time in mind before beginning, and make everyone aware what that time limit is. If your father-in-law has several positive experiences like this, there may be greater harmony in the household which could lead to reduced agitation and fewer angry outbursts.

Numerous reports have praised the emotional, cognitive and physical benefits of pet therapy in the elderly, and particularly those having dementia. Since your husband is clearly a dog-lover, he certainly stands to benefit from the companionship a dog can provide. Dogs can be very helpful to dementia patients aside from the companionship they provide. For example, some service dogs have been trained to provide assistance to the unique situation a dementia patient presents, such as alerting caregivers if the patient wanders, guiding the patient back home, and alerting the patient or caregiver to potential dangers or in situations where the patient is in need of physical assistance. Therefore, a dog can provide many benefits not only to your husband, but also to you for the peace of mind knowing that you have another pair of eyes looking out for your husband's well-being. Additionally, some reports have suggested that a companion dog can typically prolong the time a dementia patient can remain at home before it is necessary to transfer him or her to a care facility.

All of this sounds great, but the downside is that a well-trained service dog can be very expensive. Talk to pet therapy volunteer organizations in your area, or else pet rescue organizations, and let them know you are looking to find a companion dog with a good temperament that can cope with a person having potentially unpredictable behaviors. Don't forget that even if your husband loves the dog, as his disease progresses it is possible that he may someday yell or lash out at the dog for no apparent reason, and a dog having a timid or else potentially aggressive personality would not be a good match. Look for an adult dog, not a young puppy, because you want to know what the dog's personality really is, not what it might someday become.

Under the Fair Housing Act, service animals, as well as companion or comfort animals, must be allowed in multi-family rental buildings, such as an apartment building, regardless of whether the establishment has a “no pets” policy. A service dog is not a pet, it is a working animal. Therefore, if you do find yourself in the unfortunate situation of having to get another dog, speak to your landlord about your decision. Ask him what his concerns are and try to come up with ways to fairly address them. Is he worried that the dog will damage the property? The Fair Housing Act prohibits charging a pet deposit for service or companion animals, even if one is normally charged for animals living in the building. However, you could tell your landlord that you will reasonably repair any extraordinary damage the dog may cause. Is he worried about noise from the dog? Tell him that a well-behaved dog might actually reduce potential disruptions, particularly from your husband, because a dog can provide a calming effect when an Alzheimer's patient becomes agitated. You can also tell him that the dog can serve as a safety device, alerting others if your husband starts to wander or if he may be doing something dangerous when you are not home.

Patients with Alzheimer's disease (AD) often have lowered inhibitions, which may cause them to act in strange or socially unacceptable ways. For example, some caregivers report that patients may undress in public, whistle or hum constantly, or even make inappropriate, lewd or flirtatious advances towards others. So within the realm of abnormal behaviors encompassed by Alzheimer's disease, stealing objects can be viewed as “normal.”

For example, AD patients may simply have trouble remembering the distinction between what belongs to them and what belongs to others. Your mother may see something she likes and may simply take it without regard to who the object belongs. Also, some patients become paranoid or suspicious that other people may be taking their valuables, and therefore to preempt such losses, they begin to take things themselves. AD patients have been known to hoard food or other items. This behavior most likely is due to anxiety, fear, insecurity, or confusion. The hoarding is a sort of a comfort to the AD patient, as the action of gathering and hoarding often calms their anxieties.

Watch when your mother takes an object. Typically, patients will have special “hiding spots” where they will store their booty. If the items your mother is taking are not dangerous or necessary (like someone's medication), then you can just allow her to collect the items and, at the end of the day when she is asleep or else is preoccupied, you can return the items to their proper places. You can also provide gentle reminders that what she has picked up, for example, does not belong to her. Then trying offering your mother another item of interest as a substitute for the stolen object if she does not willingly give them up.

This question is a timely one, because recent research into the relationship of coffee to risk for Alzheimer's disease has revealed surprising new information. Previous research has suggested that there may be a small protective effect of moderate intake (3 to 5 cups per day) of caffeinated coffee.¹

Caffeine administered in drinking water was shown to reduce beta amyloid production in mice specially bred to express some brain changes associated with Alzheimer's disease. More recent research notes caffeinated coffee's newly discovered effect on Granulocyte-Colony Stimulating Factor (GCSF) protein.² GCSF is a substance greatly decreased in patients with Alzheimer's disease. In this study, the researchers suggested that caffeine synergizes with some as yet unidentified component of coffee and may reduce the damaging effects of Alzheimer's disease by recruiting bone marrow stem cells to remove beta-amyloid protein from the brain, by increasing the formation of new brain cells, and by promoting new brain cell connections. However, it must be noted that these studies have been done in mice, not humans.

Caution:

Caffeine, it must be noted, can have harmful effects when used in excess; furthermore Alzheimer's disease is a complex disorder, for which there is currently no known prevention or cure. Some research has generated hope that one day it might be possible to slow the progression of Alzheimer's disease, delay its symptoms or even prevent it from occurring at all. Although there is preliminary data to support the benefit of some interventions, such as physical activity and cardiovascular risk reduction, nothing at this time has definitively been shown to prevent Alzheimer's disease or other dementias.

1(Neuroscience 2006 Nov 3; 142(4):941-52)
2(J Alzheimers Dis. 2011 Jan 1;25(2):323-35)

Angiotensin receptor blockers (ARBs) have been in common use for the treatment of hypertension for some years. The most familiar of these are losartan (Cozaar), irbesartan (Avapro), olmesartan (Benicar), candesartan (Atacand), valsartan (Diovan), and telmisartan (Micardis). They all are thought to work by blocking the activation of angiotensin II AT1 receptors, which results in vasodilation, reduced vasopressin secretion, reduced production and secretion of aldosterone, and other effects. Some studies, but not all, have found decreased rates for development and progression of Alzheimer's disease in people taking ARBs for high blood pressure. Its effect on Alzheimer's prevention or delay might be independent of its effect on blood pressure, since its use has also been shown to lower beta amyloid, among other effects.

It may be time to have your father's driver's license revoked. If he has reached the point where he is making irrational threats, and particularly if he displays abusive behaviors, then he should not be allowed to drive at all because he could potentially use the car as weapon against anyone who upsets him. Your mother should contact your father's doctor and inform him or her of the situation. The doctor may be able to get the license revoked through the state DMV. Plus, the doctor can be the one to break the bad news to your father that he is no longer allowed to drive. Tell your mother that she can help to diffuse his anger by being sympathetic to the situation. For example, she can say, “That is so unfair that you cannot drive anymore. You must feel so frustrated. I would be mad too.”

For your mother's well-being I would also consider obtaining the services of a care assistant who could check in on your parents regularly and help your mother out with your father's care. Do not dismiss your father's abusive behavior. Physical violence in dementia patients is not common, but if it does happen it can cause serious harm to either or both of your parents. For this reason, talking to your father's doctor about the possibility of using mood-stabilizing medications would be very helpful.

Finally, if you live close to your parents, then it may be worthwhile to just take their car and keep it at your home. Even without a license, your father may still try to drive. He may simply forget that his license has been revoked, and therefore may need reminders from you and your mother that he is no longer allowed to drive. Therefore, if the car is gone, there will be no worry that he will try to drive. Of course, then you would be responsible for ferrying them around and yes, it may be inconvenient for everyone, but it would only be until your father lost interest in going out for drives. Even still, your mother should continue to hide the keys once the car was returned to her.