My mother has Alzheimer's disease, and has been taking Aricept and Namenda for years. Recently, her primary care physician stopped the Aricept symptoms because of severe side effects (very loose bowels and stomach pain). I am concerned that her symptoms will become worse more quickly now. Could you give me your opinion? [ 04/13/11 ]
It is true that studies have demonstrated a rapid loss of the cholinesterase inhibitor benefits following cessation of treatment. Your mother, if she has benefited from the donepezil, may show an increase in symptoms. On the other hand, it would be a shame to expose her to a medication that has probably created gastrointestinal discomfort. A transdermal delivery system, such as the patches used to administer rivastigmine, may provide your mother with the therapeutic benefits of a cholinesterase inhibitor while avoiding the gastrointestinal side effects so common with these medications.
Is there any increase in likelihood of developing Alzheimer's disease if you have had electroconvulsive therapy (ECT) to treat depression? [ 04/12/11 ]
ECT is not generally thought to increase the likelihood for developing Alzheimer's disease or other causes of dementia. In fact, ECT has been used to treat depression or agitation, common “noncognitive behavioral symptoms,” seen in dementia patients. The limited evidence available does not find ECT producing lasting cognitive impairment in patients with dementia.
Are there any scholarly articles addressing rehabilitation outcomes of Alzheimer's patients following hip replacement surgery? [ 04/11/11 ]
A strong correlation was found by Hirose and colleagues between dementia rating, walking ability and mortality a year after hip surgery (Arch Phys Med Rehabil 2010;91(1):67-72.) A similar association had been reported earlier by Cree and Nade, who found that dementia was a predictor of poorer prognosis following hip fracture (Scand J Caring Sci. 2005;19:119-27.) Delirium, a common complication of dementia, has also been found to be a predictor of poor rehabilitation outcome in elderly patients treated for femoral neck fractures (Olofsson et al. Aust N Z J Surg 1999;69:723-5.) Several studies have assessed the value of consultation and proactive efforts in reducing postoperative delirium, an intervention particularly relevant to the high-risk dementia patients.
I have frontotemporal dementia? Should I do all the things that are supposed to help people with Alzheimer’s disease? The front and side areas of my brain have decreased in size, and I have many problems, such as loss of memory for people and places. [ 04/09/11 ]
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.
Does fluoride cause Alzheimer's disease? [ 04/08/11 ]
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.
What are common problems associated with diagnosing Alzheimer's disease? [ 03/22/11 ]
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.
My mother died of Alzheimer's disease, and she used to tell me that she could feel or hear something changing inside of her head. I often hear something like a cricket sound in my head, and my brother said that he sometimes has that sensation as well. I wonder if my brother and I are experiencing what my mother was describing. Have you ever heard of such a description from people who had Alzheimer's disease? [ 03/21/11 ]
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.
Can colors improve the mood of an Alzheimer’s disease patient? What paintings or colors would most improve their mood? [ 03/15/11 ]
Researchers believe that Alzheimer's disease (AD) patients respond to colors the same as anyone else. Therefore, in the design of a room the goal should be to create a calm peaceful atmosphere to reduce anxiety and agitation. Accordingly, bright colors and vivid patterns should typically be avoided. Instead, soothing pastel shades, light blues, peaches, pinks, greens, and beige are usually recommended colors for use in homes for patients with AD. AD patients may have difficulty discriminating between similar color intensities, such as light blue or light green. Therefore, if you want to want to highlight a particular feature, such as the door to the bathroom, stairs or other obstacles, make sure you use a contrasting color.
As for paintings, one study found that AD patients who were taken to visit an art museum had better recall of paintings that could tell a story, because the patients could remember the story more than the actual picture itself. So it is possible that such “storytelling” paintings may be more interesting and, hopefully, more cheerful than a painting with abstract shapes or designs. That being said, however, because art can be so subjective, you may have to tailor the paintings to fit the patient. For example, if the patient used to be an avid fisherman or hunter, then woodland scenes or scenic rivers might be to his taste, whereas a patient who loved to garden might find pictures of flower gardens and meadows more to her liking. Stick to easily recognizable subject matter in the pictures. Basically, any painting that would make you and most other people smile would be a good choice for an AD patient as well.