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Ask an Expert about Alzheimer's Disease

Latest Questions and Answers
My mother was diagnosed with vascular dementia 4 years ago. Last September she was moved to a new nursing home with a dedicated dementia unit. I have noticed a rapid decline since her move to this new nursing home, and I am wondering if this is just the progression of the disease or if medication could be contributing to her decline. I noticed almost immediately after moving her to the new unit and Depakote was prescribed, she was no longer able to make sense when she spoke. She is also on a very small dose of Seroquel. She has lost almost 20 pounds in the past year, but has maintained her current weight for about 4 or 5 months. Any information that you can provide is appreciated. [ 12/08/10 ]

There are multiple possible explanations for your mother's decline. For someone with dementia, accommodation to change can be difficult and she may have been stressed by the move to a new environment even if the move was necessary and to a good nursing home. Changes in her daily schedule or other aspects of her new environment may have created a routine that is frustratingly beyond her current abilities or boringly understimulating. Medications, too, can produce undesirable and unintended changes such as an increase in daytime sleepiness or confusion. Both Seroquel (the antipsychotic quetiapine) and Depakote (the antiseizure medication divalproex) have been known to help some individuals but also to produce the effects that you mention in others. The course of a dementing illness can be more rapid at times, slower at others, and may account for her symptoms. Finally, a change in medical health such as onset of a urinary tract infection is sometimes the explanation for an unexpectedly rapid clinical decline. Other medical conditions, too, can account for mental status changes and also for weight loss. Your mother is probably due for a review of her medications, living circumstances, daily schedule, and medical health status in order to assess whether changes in any of these might slow her recently accelerated decline.


What are STEP proteins? [ 12/03/10 ]

STEP is an acronym used for convenience and refers to "STriatal-Enriched tyrosine Phosphatase," a protein associated with the regulation of learning and memory. In mice with a condition similar to Alzheimer's disease, lowering the level of STEP reversed cognitive deficits. A current leader in work on STEP, Dr. Paul Lombroso at Yale School of Medicine, has stated that beta amyloid activates STEP, which in turn interferes with glutamatergic neurotransmission*, and that this effect may be an important contributor to impaired learning and memory in Alzheimer's disease. Increase levels of STEP may contribute to the problems seen in other diseases as well, such as schizophrenia and Fragile X syndrome. Current research is evaluating the treatment implications of findings relating STEP to cognitive impairment.

*Glutamatergic neurotransmission: nerve cells that communicate with one another using the glutamate molecule.


My 78-year-old husband is extremely well educated and speaks 6 languages, but has all the classic symptoms of Alzheimer’s disease. He needs help with all daily living activities and cannot remember anything. I am limiting his driving to daytime and only to places that he is familiar with, such as the grocery store and church. Soon, however, he will need to stop driving entirely. His doctor gave him a 5 minute test and said that he does not have Alzheimer’s disease. Why is it so hard to get a diagnosis for this disease? [ 12/02/10 ]

Your husband should be evaluated thoroughly by a behavioral neurologist or a neuropsychiatrist, if available, since they are familiar with the brain conditions that affect behavior, and more extensive testing should be done. An intelligent, highly educated individual may perform well on the simplified cognitive screening tests that are sometimes done in primary care settings, yielding a misleading impression that dementia is not present. On the other hand, dementia is not the only condition that can result in forgetfulness. Alzheimer's disease is the most common dementia, but not the only one, so if your husband does have dementia it is still valuable to refine the diagnosis in an effort to individualize his treatment. Finally, I'd advise that he stop driving right away pending further assessment. Although a significantly cognitively impaired individual may retain the capacity to drive safely under optimal conditions, something as routine as a child running in front of the car might result in confusion and impaired reaction, resulting in a tragic outcome.


My wife has had amyloid deposits surgically removed from her eyes, and it is the only such condition that her eye doctor has ever seen. The biopsy was sent to an expert in Atlanta, and he had never seen this condition before either. Was the amyloid that was removed from her eyes a precursor to Alzheimer’s disease? [ 12/01/10 ]

Although I do not know the details of your wife's ophthalmologic problems, ocular accumulation of beta amyloid is well recognized. Glaucoma or cataracts may be early complications of this process. Beta amyloid accumulation occurs not only in Alzheimer's disease but also in Down's syndrome, another condition in which beta amyloid can accumulate (resulting in early-onset dementia). The possibility of detecting Alzheimer's disease at an earlier stage through ocular examination has been raised and you may wish to read more about it (see for example the review by Frost and colleagues in the Journal of Alzheimer's Disease, 2010, 22:1-16). They emphasize that the eye is connected by nerves to the brain and that the eye is a unique site for observing vasculature and neural tissue non-invasively. Whether your wife's condition is a forerunner to the development of Alzheimer's disease later in life is not clear, but she should certainly be followed by ophthalmologists who can help her avoid damage to her vision. For more information concerning the technology to examine ocular beta amyloid, please read about the research of Dr. Lee Goldstein, which is funded by our organization.


I have read that amino acids can help a person who has Alzheimer’s disease. Please let me know if you have any information on this topic. [ 11/30/10 ]

Amino acids are simple molecules that serve as the building blocks of proteins. Since proteins are necessary for many biological processes, we need to have these amino acids available. Most can be produced within our own bodies, though some are obtained only through dietary means. A diet with adequate protein intake should not lead to amino acid deficiency in a healthy individual, and there is no solid evidence currently that extra supplementation with amino acids alone is helpful in preventing or treating Alzheimer's disease.


Why does amyloid beta aggregate into plaques and fibrils? What exactly is involved in the process of amyloid beta forming monomers, dimers, trimers, oligomers, protofibrils, fibrils, and eventually plaques? I'm really interested into the biochemistry of amyloid beta in pathogenesis of Alzheimer's disease. [ 11/30/10 ]

Amyloid beta is a protein, which means it's a string of amino acids linked through chemical bonds. The fibrils result when peptide strands bind together as a result of the molecular characteristics of the amino acids. Amyloid plaques are sheets of the fibrils bound together as a result of electrostatic and chemical bonding. The precise mechanism through which amyloid causes Alzheimer's disease (if indeed it does) remains unclear, but likely involves interference with synaptic transmission as well as instigation of neuron-killing local inflammatory reactions.


My mother is in the moderate stage of Alzheimer’s disease. She lives in her own home now; however, we think it's time to move her in with family during the next couple of months. Does anyone know how disruptive it would be if she lived with my brother for 3 weeks and me for 1 week each month. My sister thinks it would be best for mom if she moved into an assisted living facility. I appreciate your thoughts on this issue. [ 11/10/10 ]

If it is not possible for you or your brother to keep your mother in one location the entire time, then it might be better if she went to live in an assisted living facility. Predictable routines and environments are typically best for Alzheimer's patients because without such predictability, patients can become easily disorientated and confused, which can lead to anxiety and other behavioral issues. It is wonderful that both you and your brother plan to share responsibility for the care of your mother, but continually relocating her “home” may become a problem as her disease progresses and she becomes less able to adapt to change. Perhaps it seems overwhelming for either you or your brother to take on full responsibility for your mother's care and this is why the joint-custody situation seems appealing. Even though it may appear sensible to consider share custody, it is not ideal for an Alzheimer's disease patient.

Perhaps you and your brother can make other arrangements wherein you both are still involved in your mother's care, but she lives with only one of you full-time. For example, if you mother lived at your brother's home all the time, then you could assist in her care by running errands for your brother, providing some financial assistance, and/or providing respite care on a regular basis so that your brother can take time for himself. An overnight stay at your home might also be okay once or twice a month, but you will need to gauge your mother's reaction to these visits as to whether or not they cause her excessive confusion or anxiety. If an alternative arrangement with your brother is not possible however, then your sister may be right: it may be best to move your mother into a place where she will have a stable and consistent home environment.


My mom is 84 years old and was diagnosed with Alzheimer’s disease approximately 10 years ago. She does not talk and is confused all the time. Lately, she often just sits and she keeps her head down. In fact, her head is way down to her knees most of the time. She looks very uncomfortable. We have tried several things to keep her head up, but it keeps going down again. Is this a part of the disease? Do you have any suggestions? [ 11/10/10 ]

Stooped posture is fairly common in patients with Alzheimer's disease (AD). In some instances, a patient may lean quite significantly to one side or lean forward (such as in your mother's case), in which case it might be called Pisa Syndrome. This stooped posture can also occur in patients with Parkinson's disease (PD) and Lewy Body dementia (LBD). AD can affect brain areas responsible for muscle tone and balance, and therefore gait, postural and balance disturbances can arise. Sometimes, these disturbances are a result of AD medications (such as cholinesterase inhibitors). So it may be helpful to review your mother's medications with her doctor as well as to determine if any other medical factors (PD or LBD) are at play. If her posture is caused by her medications, then adjusting the dose and/or discontinuation of the medication (only on her doctor's approval) should help to resolve the problem.


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Disclaimer: The information provided here is a public service of the BrightFocus Foundation and should not in any way substitute for the advice of a qualified healthcare professional; it is not intended to constitute medical advice. Please consult your physician for personalized medical advice. BrightFocus Foundation does not endorse any medical product or therapy. All medications and supplements should only be taken under medical supervision. Also, although we make every effort to keep the medical information on our website updated, we cannot guarantee that the posted information reflects the most up-to-date research.

Some of the content in this section is adapted from other sources, which are clearly identified within each individual item of information.

Last Review: 04/29/13


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