Ask an Expert about Alzheimer's Disease

Frontotemporal dementia (FTD) comprises a group of disorders that are separated from Alzheimer's disease by their different microscopic pathologic findings in brain tissue, and by their different course of symptoms. No specific medications are FDA-indicated for the treatment of FTD, though many patients are put on cholinesterase inhibitors or memantine in an effort to see if they provide some benefit. The cholinesterase inhibitors such as donepezil, rivastigmine, or galantamine have not been consistently helpful to patients with FTD, however.

The safety of fluoride, added to drinking water as a preventive treatment for tooth decay, has been questioned by various groups concerned about its possible toxicity. With Alzheimer's disease, however, no firm evidence supports a harmful effect of fluoride. To the contrary, there is speculation that fluoride may have a beneficial effect by competing with aluminum for absorption, which is suspected to be neurotoxic; however, this has not been proven.

Bathing and personal hygiene are always difficult issues to deal with. It sounds as though you are really understanding and patient, which is commendable considering how frustrated I'm sure you must feel sometimes!

In general, motivating a patient with Alzheimer's disease to do something is more about gaining his cooperation rather than forcing him to do a task. Some techniques you may find helpful (if you haven't already tried them) include:

• Ask him to try to do something rather than tell him to do it.
• You can also make him feel like he has some control of the bathing situation by saying “The bath is ready for you whenever you are.”
• Keep instructions simple and clear. Avoid lengthy explanations.
• Bribe him with a favorite food or drink as a reward for changing his undergarment.
• Call the diaper an undergarment or underwear instead—he might be embarrassed by the word “diaper.”
• Offer simple choices. For example, ask him “Do you want to get changed by yourself or do you want me to help you?”
• You can also ask him to help you with the task. Everyone likes to feel needed, so if he thinks that he can be of assistance to you, you may find he is more willing to cooperate. Don't forget to praise him for his efforts.
• Maintain a pleasant and calm tone of voice. Sometimes how you say things is just as important as what you say. And don't forget to try to smile.
• Stick to a routine. For example, always try to get him to change his undergarment at least in the morning before he gets dressed.
• If all else fails, leave him alone and try again later using a different approach. It will give you an opportunity to calm down and reassess the situation if you are feeling frustrated. Also, his mood may change in the meantime, and he may be more amenable later. Don't continue to push him if the technique you are using is not working.

The laws pertaining to adult guardianship vary from state to state, and when the battle over the custody of an elderly parent crosses state boundaries, the case can become quite complicated. If the daughter in your state has not already done so, it would be best that she contacts an attorney who specializes in elder issues. Such attorneys can be found, for example, through the ElderLawAnswers organization and the Administration on Aging.

In my professional opinion, a living arrangement in which the residence of an Alzheimer's patient is changed every 6 months seems unnecessarily disruptive and could potentially increase the occurrence of anxiety, agitation, or other negative behavioral issues. If it is possible for your friend to present any evidence to the judge, then a signed statement by her mother's doctor indicating that such a living arrangement would not be in the mother's best medical interest could be influential in court.

In response to your first question, your hunch is correct. The area that is responsible for being able to read is distinct from the areas required for carrying out a conversation and formulating questions and answers. A conversation requires much more complex thought than simply reading out loud. For example, just because your mother reads out loud does not necessarily mean that she actually comprehends the text. In this sense, reading out loud is like being on “auto-pilot”—the recognition of words and how they are pronounced may still be intact, but their individual meaning, as well as the meaning of the text as a whole, may be lost.

Transient ischemic attacks, or TIAs, are an important risk factor in predicting if a stroke will occur. Most studies indicate that in a third to a half of all stroke cases, the stroke was preceded by a TIA. Because your mother has had a number of recent TIAs, there is high probability that she will suffer a stroke, most likely within the next year, if not sooner. Please talk to your mother's doctor, who will be able to provide you with more information that is specific to your mother's condition and answer any additional questions you may have.

Diagnostic problems generally fall into the categories of "false positives" (people incorrectly diagnosed with the disease who do not have it), or "false negatives" (people who have the disease and are incorrectly diagnosed as NOT having it).

Sometimes the false positives can result from other disorders that affect cognition, such as depression, delirium, medications, substance use, or a wide range of medical disorders. The false negatives can arise when a person's cognitive level prior to becoming ill was so high that functional reserve covers any growing deficit. In addition, since the diagnosis of Alzheimer's disease is based on a clinical syndrome rather than a definitive diagnostic test using blood, cerebrospinal fluid or brain imaging at this juncture, an atypical presentation can confuse clinicians. Some patients present with a disturbance of visuospatial or language functions that are more clearly apparent than the disturbance of cognition, which again confusing matters. When cerebrovascular disease is also present, the diagnosis may be "mixed," or the cerebrovascular disease may distract attention from the Alzheimer's disease. These are some of the common variations and problems in the diagnosis of this neurological disorder.

The sensation that you describe has no link to Alzheimer's disease that I am aware of, but is often referred to as one of the characteristic presentations of "tinnitus," which is the perception of sound within the ear that is not related to any external sound. This symptom should be medically evaluated. It often occurs as a consequence of prolonged exposure to high levels of noise, but it can also represent a serious medical condition such as a blood vessel disorder, high blood pressure, narrowing arteries, or even (rarely) brain tumors.

Dementia is a term that describes a condition of decline from previous cognitive functioning, not explainable by adverse medication effects or other simple reversible medical causes. In addition, it is characterized by memory problems and problems in one or more other areas such as recognition, ability to do learned tasks, use language, or to problem-solve. Alzheimer's disease is the most common dementia, and accounts for two thirds of the dementia cases among older adults in the United States.

The best approach to dealing with an argumentative or physically aggressive Alzheimer's disease patient (AD) is to try to change the subject or get the patient engaged in a new activity. You are doing the right thing by remaining calm and generally ignoring her comments. Arguing with an AD patient never accomplishes anything, and usually just serves to further agitate the patient.

Determine what your mother's favorite topics are and try to engage her in conversations concerning these subjects. It doesn't matter if she gets names, places or dates wrong—don't bother correcting her unless she asks—just let her talk. Or get her hands engaged in something that will take her mind off of her agitation, such as folding laundry, kneading dough, arranging flowers in a vase, drawing a picture, etc. These activities also can potentially serve to give her a sense of accomplishment and usefulness. Just remember to keep the tasks simple and clearly explain and/or demonstrate the steps involved.

Additionally, if you have not done so already, you may want to try keeping your mother on a fairly regular schedule each day. You can also try posting a large calendar or agenda on the wall that clearly lists the day's and week's activities. Post a schedule next to the clock with the times for each activity (e.g., listing mealtimes, different activities, bathroom breaks, bedtime, etc.) This can help to lessen anxiety about what's coming up next, which may aid in reducing aggressive outbursts.

Your mother may have moments of clarity in which she realizes that her cognition is deteriorating. She may not be able to remember a word or a face and this can be scary. It is also possible that she may be ashamed that she cannot remember the family member who just visited, and therefore becomes defensive when you insist otherwise. Even though this behavior is frustrating (to both you and her), it is all perfectly "normal" for Alzheimer's disease.

Most caregivers say that taking care of a loved one is one of the most difficult jobs they have ever done, and also one of the most rewarding. Every day can present new challenges, but you have to remember your mother's actions are no longer her own, as they are influenced – and sometimes completely governed—by the disease.