Is losing the sense of smell a symptom of Alzheimer’s disease? If so, during which stage of the disease does this symptom occur? [ 01/21/11 ]
For several decades, researchers have recognized that impaired sense of smell is an early characteristic of Alzheimer's disease. The olfactory bulb and tract show degenerative changes early in the course of the illness, so investigators have developed "scratch and sniff" odor recognition tests in hopes of increasing early identification of Alzheimer's disease. These tests look for changes in the detection, identification, discrimination, and memory of odors. Since baseline olfactory measures are rarely available when such a test is administered to someone with a possible illness, it can be difficult to be sure that impaired ability to smell was not present all along. Furthermore, sometimes impaired sense of smell is the result of mechanical problems in the nasal cavity such as polyps or a deviated septum. The false positives (identification of people with impaired sense of smell but who do NOT have Alzheimer's disease) in smell tests have made this approach less popular than some more reliable diagnostic tests.
My mother was diagnosed with vascular dementia 4 years ago. Last September, she was moved from her older nursing home to a newer one that has a dedicated dementia unit, because the original home could not handle her anymore (she kept going outside and was disruptive with other patients). 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 the changes are related to her medications. I noticed changes immediately after she was prescribed Depakote, as she no longer made sense when she spoke. She is also on a very small dose of Seroquel. She has lost about 20 pounds in the past year, but she has been maintaining her current weight for about 4 or 5 months now. I would appreciate any information that you give me. [ 01/11/11 ]
The "non-cognitive behavioral symptoms" or NCBS of dementia often create more day to day difficulty than mere memory loss, as your mother's condition illustrates. She may need the attention of a skilled geriatric psychiatrist to sort out which of the many causes of disruptive behavior is most important in her particular case. Just as you point out, her disruptive behavior could reflect the progression of her dementia, the occurrence of a separate medical problem such as a stroke or a urinary tract infection, the development of a separate psychiatric problem such as depression (which is very common in this situation), the move to a new nursing home, the adverse effects of divalproex (Depakote) or quetiapine (Seroquel), or anxiety. With all of these choices, each of which would suggest a different course of action, some careful analysis must go into diagnosing your mother's condition. Her disease may make it impossible for her to rely on memory and new learning to improve her behavior, but a successful dementia unit often can apply behavioral methods to reduce disruptive behavior. If these fail, one or more of the available medications may be helpful. I hope this information will help you work with your mother's nursing home staff and a good consultant to improve her behavior and the quality of life for her and her caregivers.
I live in rural India, and my father was admitted to a hospital for an angioplasty. Subsequently, a blood clot developed, traveled to his brain and then dissolved. After that, he has exhibited classical signs of Alzheimer’s . After lunch, I give him .25 milligrams of alprazolam so that he can sleep, but this often does not help. After dinner, I give him .50 milligrams of the same medication, and this does seem to help him sleep through the night. He often has high levels of anxiety for approximately three hours before dinner and we don’t know how to manage it. The medicines prescribed to him by psychiatrists and neurologists increased his anxiety and prevented him from sleeping. He requires assistance in walking and changing. Should I increase his sedation? We tried giving him 1 milligram of lorazepam at night but it only disoriented him and kept him awake. [ 01/10/11 ]
I am sorry for your father's and your family's misfortune. His behavior may suggest Alzheimer's disease, but the occurrence of these symptoms after angioplasty and a clot to his brain suggests the possibility of vascular dementia as an alternative. Either way, the treatment of his anxiety appears to be the primary concern. Although I cannot give specific advice about the best medications for your father without knowing many more details of his health, I will suggest that you speak with his doctors to find a better approach than the use of alprazolam. This benzodiazepine sedative, like lorazepam, often reduces anxiety but at the same time interferes with aspects of mental functioning such as concentration and memory. Furthermore, a rebound anxiety may occur as one dose wears off and the next has not yet been given. Although behavioral approaches are considered the safest for addressing anxiety and agitation, many clinicians now also use antidepressants such as citalopram, antipsychotics such as quetiapine (though metabolic concerns may limit appropriateness of this choice), or anti-seizure medications to treat the symptoms you are describing.
My wife has been taking Namenda and galantamine for about 4 years. Is there any evidence that these medications are still working to slow the progression of her Alzheimer’s disease? [ 01/06/11 ]
Galantamine, the generic form of Razadyne, is a cholinesterase inhibiting medication approved by the FDA for treatment of mild to moderate symptoms of Alzheimer's disease (AD). Namenda, the brand name for memantine, works through a different mechanism that improves glutamate neurotransmission, and is also approved by the FDA for treatment of moderate to severe symptoms of AD. Studies have shown that these medications continue to benefit patients for at least up to 2 to 3 years. An encouraging study found benefits of combination therapy in AD patients followed for an average of 30 months, but we don't have enough information to prove that treatment for 4 years remains beneficial. Clinicians who continue these medications do so based on the absence of other helpful treatment approaches, the belief that such combination treatment is not harmful, and the possibility that continued treatment may help in various ways such as slowing cognitive deterioration, slowing loss of ability to perform activities of daily living, delaying the emergence of disruptive behaviors, and reducing caregiver burden. On the other hand, some patients and clinicians decide to discontinue treatment on the basis of unwanted side effects such as fatigue or dizziness, apparent lack of benefits, or cost considerations.
My doctor says that I have white flakes showing up in an MRI of my brain, but he did not explain further. What do the flakes mean? [ 01/06/11 ]
Your MRI may have shown 'flecks' of brighter areas on the MRI that reveal a condition called 'white matter disease.' There are many different causes of 'white matter disease,' and some are more serious than others. In older adults, disease of the small blood vessels can lead to characteristic 'white matter disease findings' on the MRI. When the small vessel disease is serious, it can be associated with cognitive changes, but the presence of mild white matter changes does not necessarily mean that severe cognitive impairment is present. Some causes of 'white matter disease' are treatable, so your doctor should discuss this finding with you further. Making the most likely diagnosis will require your doctor to consider your age and medical history as well as any current symptoms. He or she may also refer you to a neurologist for a more detailed further examination.
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.
Read all of our recent Ask an Expert responses.
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.