My brother was diagnosed with Stage 1 Alzheimer's disease about 18 months ago, and his wife put him in a home. He has never been violent until the one time he shook her. He has suffered from depression for many years, and he is again talking about suicide. He says that he doesn’t want to go on with life. I live 6 hours away from my brother, but try to visit him once every few months and email him once a week. I love him very much. Are the depression and suicidal thoughts typical symptoms of the Alzheimer’s disease? [ 01/04/11 ]
Depression is a fairly common problem in Alzheimer's disease patients, particularly those in the early stages of the disease who are aware of their own cognitive decline. One study found that a diagnosis of Alzheimer's disease by itself increases the risk of both depression and suicide in elderly patients. This study reported that people who had a higher level of daily functioning (that is, they generally had mild symptoms or were in the early stages of the disease) and had previous suicide attempts were at an elevated suicidal risk. In agreement with these findings, a more current study (Draper et al. Alzheimers Dement. 2010 Jan; 6(1):75-82) also indicated that early diagnosis of Alzheimer's disease or other dementia may actually increase the risk of suicidal thoughts.
Therefore, if you have not already done so, please talk to your sister-in-law about your concern for your brother. You or your sister-in-law should also alert the staff at his care facility that your brother has been having thoughts of suicide. The staff may already be aware of this, but it won't hurt to relay your concern. Talk to his doctor as well; your brother's antidepressant medication may need to be adjusted. You or your sister-in-law may also consider insisting that your brother see a mental health professional who has experience with the elderly and with dementia.
Finally, continue to visit, write or call your brother as much as possible. In addition to the weekly emails, consider calling him once or twice a week and sending him a hand-written letter. A paper letter is something he can actually hold, touch, and re-read whenever he wants, not just when he has access to a computer. And when you speak to him, be sure not only to seem genuinely interested in what he has to say, but also tell him that you love him and are concerned about him. Additionally, you might consider contacting a suicide hotline on behalf of your brother for more assistance and advice.
Is there a relationship between drinking alcohol and getting Alzheimer’s disease? [ 12/30/10 ]
A recent extensive review prepared for the Agency for Healthcare Research and Quality (www.ahrq.gov) concluded that light to moderate alcohol users benefited from a small protective effect against Alzheimer's disease. Heavier drinkers did not appear to be at greater risk than the general population; however, two important cautions should be considered:
- In cognitively impaired individuals, alcohol can have a significant influence on the ability to think and reason, and therefore someone with dementia should limit if not abstain from use of alcohol.
- Heavy alcohol use can impair cognitive function without causing Alzheimer's disease. A syndrome called "alcoholic dementia," which significantly affects memory and other cognitive functions, describes the severe effects that alcohol has in some heavy drinkers.
Alcohol consumption should always be discussed with a physician who is familiar with a patient's medical history and current medication regimen.
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Can you simplify the process of how plaques and tangles affect the brain during Alzheimer’s disease without using medical terms? Does a healthy brain have any plaques or tangles forming at all? [ 12/29/10 ]
Plaques seem to occur because an abnormal kind of protein clumps together, causes a reaction from the blood and immune system, and results in globs of dead brain cells that no longer can process information or make the body do what it should. Tangles result when the inner workings of brain cells are chemically altered, get all twisted and cannot do what they are supposed to, which is to help the cell function properly. Plaques and tangles can be seen in the brains of older adults who do have dementia, but patients with dementia due to Alzheimer's disease have lots more plaques and tangles, especially in certain parts of the brain involved with memory and other kinds of thinking.
My co-worker has had increasing difficulty with memory loss over the past 2 years. Her son has also noticed changes in her memory and advised her doctor to test for Alzheimer's disease during her last office visit. Of course, the doctor mentioned this request to his mother and she denied any problems. She feels that she has always had issues with poor memory and that these symptoms are not unusual for someone who is 76 years old. After she told me of that incident, I felt obligated to tell her that I too have noticed that she has had difficulty remembering things, and received the same response that she gave her doctor. Is there any way that her son can help her? [ 12/28/10 ]
It is common for minor cognitive changes to accompany aging, and your co-worker may be experiencing normal changes or more significant changes. Difficulty with memory can be a longstanding issue or a new problem and there are many potential causes, so Alzheimer's disease is only one of the possible explanations. Some of the conditions that interfere with memory, such as use of certain medications, can be helped relatively easily, but without evaluation the opportunity to help will be missed or inappropriate treatment may be recommended. Perhaps your co-worker can appreciate the importance of assessing her memory more formally in order to reassure everyone that the memory difficulties are normal for her age, or to make sure that a potentially harmful but treatable medical condition is not overlooked and allowed to progress. Otherwise, it may be necessary to wait until her job performance is impaired enough to require the intervention of a work supervisor to discuss this with her.
My mother keeps asking about her children and thinks that they are still young. How can I help to calm her down when she wants to be with them? [ 12/22/10 ]
The fact that your mother thinks that her children are still young is not that uncommon for an Alzheimer's disease patient, who often confuse the past with the present. Your mother may be remembering a time when she felt needed and valued, and therefore may have a desire (a subconscious one, granted) to return to this “happier” time in her life. This is probably why, when you inform her that her children are grown now, she becomes upset. There isn't much point trying to reason with or use logic on a dementia patient—they often are so far into their own reality that arguing with the patient will only serve to agitate them even more. In this instance, therefore, it might be best to play along with your mother's questions for a while, then try to change the subject to something less distressing.
Additionally, you might want to consider doll therapy as a means to help your mother. Doll therapy involves giving a doll baby or teddy bear to a dementia patient and allowing them to interact with the doll in whatever way they want (i.e., dressing the doll, feeding it, rocking it to sleep, etc.) One formal study found that patients given dolls to “care for” tended to be more communicative with caregivers and less prone to negative behaviors, such as agitation or anxiety. Doll therapy seems to bring out the nurturing instinct in many dementia patients, particularly females, who may be reliving memories of being a mother of an infant, a time in their lives when they were very much needed and useful.
Non-formal observations by caregivers recommend that the doll be as lifelike as possible, and be introduced to the patient while he or she is still in the early stages of the disease to allow time for bonding with the doll. Given in the later stages, the doll may be less effective.
My mother was diagnosed with Alzheimer's disease 5 years ago. She has lived with me for the past 4.5 years. She takes Namenda, Aricept, Singulair, Amatiza, Mucinex, a multivitamin, a B complex capsule, vitamins C and D, calcium, melatonin, magnesium, potassium, an omega 3 supplement, 81 milligrams of aspirin, and a probiotic. Her physician is aware of what she takes. For the past year, several times a week, she complains of body aches. She states she aches from head to toe. I took her to the doctor and she suggested that we take her off all of the supplements. I did and nothing changed, she still ached. She does not have a history or any other signs of arthritis. She has become less active, so I have her going to adult day care 2 times a week. At day care, she exercises and moves around the room. At home, her normal routine is to get up in the morning and head to the couch and lie down. Are the body aches a normal Alzheimer's symptom? [ 12/20/10 ]
Alzheimer's disease is not typically associated with body aches, so it is most likely something else that is causing your mother's pain. Vitamin B12 deficiency can sometimes cause body aches, but since your mother is on a vitamin B complex supplement, this probably is not the cause. Low progesterone levels are also a culprit in some instances, and a routine blood test could determine her hormone levels. However, based on your description, it is possible that your mother might have depression, chronic fatigue syndrome, or possibly even fibromyalgia. It is not uncommon for dementia patients to suffer from depression, and depression can provoke symptoms such as fatigue and chronic pain. In fact, chronic pain and depression are so interrelated it is sometimes difficult to determine which condition started first. It would be prudent to ask her doctor to review her medications and possibly give her another check up regarding the body aches and pains, and to check for signs of depression as well. Only he or she can help to narrow down the causes of your mother's pain.
You are right to encourage your mother stay active both socially and physically, as well as to drink plenty of fluids to stay hydrated—these are both excellent ways to keep muscles and joints healthy and (hopefully) prevent more serious aches and pains. Also, you say that you are at work all day. It is possible on these days your mother is simply bored at home. On the days your mother is not at adult day care, perhaps you can arrange for an in-home visit by a nursing assistant or family friend to check in on her and encourage her to move around, along with providing social stimulation.
Why does my father keep saying he is going home to see his mother? What do I say to him? [ 12/19/10 ]
The desire to return “home”—be it their last residence or their childhood homestead—is very common in patients with Alzheimer's disease. Patients also often confuse the past with the present. You father may be saying that he wants to go home to see his mother because that is a place he may have felt safe or needed. Sometimes, Alzheimer's disease patients feel like they are a burden to their caregivers, or else they may feel like they are no longer a valued member of the family or of society in general. They feel as though they have lost their definition of who they are.
So the next time your father says he is going to see his mother, try to get him to talk about it a bit more to see if you can determine the underlying emotion behind his repeated statements of returning home. You can draw him out by asking him to tell you more about his favorite memories of home and of his mother and family, etc. Even if you've heard the stories before, just let him talk. Does he feel threatened, scared or lonely in any way? Does he feel useless or depressed? Really listen to what he is telling you and try to read between the lines. Once he is finished telling his stories (and once you think you might have some idea about the emotion stemming from his statements) be sure to reassure him that he is loved and valued, and that he will be loved and well-cared for no matter what happens. Repeat this as necessary, continuing to reassure him and soothe his anxieties and fears.
I am a 49-year-old woman and have Alzheimer’s disease. My dad, his mother, and six brothers and sisters all died from this disease. I know what I went through when I took care of my dad. He was once a man and twice a child. I don’t want my kids to go through what I did as a teenager. Please help. [ 12/18/10 ]
If you have not done so already, now would be a good time to sit down with your family lawyer and work out your finances and end-of-life planning. Although it may be very difficult to discuss with your family, this is something that needs to be dealt with now. I understand your desire to not want to burden your family, and therefore the sooner you have this conversation with your family, the better for all involved. Your family may not have any idea about how you want to be taken of, so you will need to inform them of your desires while there is still opportunity to plan. At the very least, you need to make some tough decisions to sort out your finances, establish a living will, and put in place any other advanced directives. These are things that you can have in place now that will help your family in the future. No one wants to think about these things, but they are absolutely essential for preparing for what lies ahead.
There are treatment and care options available now that probably were not available when your father suffered from the disease. For example, there is more availability to skilled nursing care at home now, and there are drugs that can improve functionality and thus prolong the time before such skilled care is needed. There are also assisted living facilities that might be an option depending on your family situation.
In the meantime, don't beat yourself up. This is certainly not something that you asked to have happen to you and there was no way to prevent it from happening. Now that you have the diagnosis, try to be realistic and practical about your health and what you can still control. As much as you are able, stay active and healthy by eating a well-balanced diet, getting regular exercise, and going for regular doctor and dental check-ups. You may ask what the point is now. The point is about maintaining your physical and emotional health as much as you are able—think of it as one less thing your family will have to worry about. For example, regular exercise and other healthy habits can help to stave off depression, diabetes, high blood pressure, etc., which are all things that may complicate your care down the road. And be sure to talk to your doctor if you feel depressed or overly anxious—prescription medication might be of help in these instances.
It also may help to talk to others who have recently been diagnosed with the disease. Their overall situation may not be identical to yours, but they undoubtedly will be facing many of the same decisions that you will have to make and may therefore be a source of support and comfort to you.