I am a psychologist treating a 57-year-old severely depressed woman. While she was admitted to a psychiatric hospital, she was given six electroconvulsive therapy (ECT) treatments. When she was discharged, I noted a severe decline in her cognitive function. Neuropsychological testing has indicated that she is showing deficits suggestive of early Alzheimer's disease. Are people predisposed to Alzheimer's disease likely to be severely damaged by ECT? I appreciate your input. [ 09/21/11 ]
Your question suggests you may feel that you have endangered your patient by going along with the referral for ECT despite the patient's family history of Alzheimer's disease; however, there is no evidence for a harmful effect of ECT in such circumstances. There is evidence to the contrary that untreated depression may be a risk factor for dementia and ECT is a powerful treatment for depression. You will be interested also to know that some treatment centers now administer ECT to dementia patients whose aggression or agitation creates serious obstacles to care at home or in a long-term care facility. Several case studies have been reported in which symptomatic response with acceptable side effects was documented. Although ECT can interfere with short-term memory, this effect is considered temporary in dementia patients as in cognitively intact ones, and the behavioral benefits of a successful course of ECT may well outweigh the potential risks.
That said, ECT for dementia patients must be used with caution because of the possibility that cognitive impairment may reflect a medical condition that should be independently identified and treated. Appropriate informed consent (from a competent patient or an authorized health care representative) must be obtained. Adverse effects can be minimized by using modern ECT technique that emphasizes delivery of minimal current using a unilateral non-dominant hemisphere electrode placement and properly scheduled sessions.
My mother is 73 years old. Almost all of her 15 older siblings died in their 70s when they had Alzheimer disease. My maternal grandfather suffered from Alzheimer disease also. Needless to say, this illness runs in her family. My mother is exhibiting early symptoms of this brain disorder, but she refuses to take a special test to provide her with an accurate diagnosis. What should I do? [ 09/02/11 ]
There are so many reasons why a woman in your mother's circumstances might avoid taking a diagnostic test for Alzheimer's disease. If you start by figuring out the reasons for her reluctance, you may be able to decrease her resistance. Is she convinced that she has no cognitive symptoms? Given her family history, acknowledging the presence of symptoms would be very threatening! Could she be depressed, anxious, or medically ill in a way that is affecting her cognitive functioning? Is she demonstrating symptoms but already unable to appreciate their significance? If that's the case, asking her primary care clinician to incorporate a simple screening test such as the MiniCog or the Montreal Cognitive Assessment into her routine assessment may be a good way to increase the accuracy of her diagnosis.
My husband, who is 76 years old, has been in an assisted living home for almost one year. He no longer tries to feed himself, is wheelchair bound, and is dependent on others for his needs. He eats and swallows successfully, but sometimes I still see food in his mouth when he is taking another bite, even though he has quit chewing. Also, I never know when he is hungry or full. Are these behaviors common during the final stages of the disease, and approximately how long will this stage last? Also, is my husband still capable of feeling emotions? [ 09/01/11 ]
Apraxia, the loss of ability to perform previously familiar actions, is characteristic of Alzheimer's disease and is increasingly common as the disease progresses. Eating and swallowing, actions so automatic for most of us, can become difficult and confusing in the late stage of Alzheimer's disease.
Determining whether your husband is hungry or full also presents problems, because even if he is able to use the words, he may not fully recognize and understand the messages his body is sending him about hunger or satiety.
The course of Alzheimer's disease is variable, with an average of about 7 years from diagnosis to death, and about 1 to 2 years often spent in the late stage. Your husband almost certainly does feel emotions and will continue to do so. Though he may not be able to tell you so in words, he may be distressed if he exhibits sadness or frustration, and comforted by a kind look, a soft touch, or a calming tone of voice.
In the summer 2011 issue of the Alzheimer's Disease Research Review, you mention that drugs such as aspirin, ibuprofen, and naproxen reduce the effectiveness of the most widely used class of antidepressant medications. I do not use any antidepressant medications because I am not depressed; however, my heart doctor has prescribed a daily baby aspirin. The article did not mention whether anti-inflammatory drugs caused Alzheimer's disease, so I am curious if long-term use of such a tiny dose of aspirin could increase the risk of developing this neurological disorder. [ 08/31/11 ]
Inflammation is thought to be an important contributor to the brain destruction in Alzheimer's disease, and some evidence has suggested that taking anti-inflammatory medications might have a protective effect against cognitive decline and dementia. The best support for this theory comes from epidemiologic studies (without support from clinical trials), so a beneficial preventive effect of anti-inflammatory medications like aspirin is not firmly established; however, a small daily dose of aspirin (used under the supervision of a physician) may have health benefits and there appears to be no evidence that it will increase the risk for Alzheimer's disease.
My wife has had Alzheimer’s disease for nearly eight years. She is likely in the mid- to late-stage of the disease and is using the Exelon patch. She is currently recovering from a urinary tract infection (UTI). She lies on her back all night and when she tries to rise up, she has tremendous head pain. It usually subsides after sitting up for few minutes, but it seems severe. What could be the cause? [ 08/16/11 ]
Was your wife's headache present before the UTI? If not, the Alzheimer's disease may be a red herring and the headache may be her body's response to the infection, to the antibiotics used to treat the UTI, or to an associated dehydration. There are many additional possible causes as well, and a thorough medical or neurological assessment may be helpful in pinpointing the cause of your wife's headaches. On the other hand, headaches are not unusual in people with Alzheimer's disease. Takeshima and colleagues, for example, reported in 1990 that about a quarter of the people their study with dementia complained of headaches. About half the headaches seemed to be “tension headaches,” so it might be possible to help your wife with appropriate use of pain relievers and/or stress reduction techniques.
What are the psychosocial elements which affect the onset of Alzheimer’s disease? Is it known which psychosocial elements interact with genes to affect the onset of this brain disorder? [ 08/15/11 ]
First, it must be cautioned that an independent panel at a recent National Institutes of Health State-of-the-Science Conference found insufficient evidence to support the association of any modifiable factor with risk of cognitive decline or Alzheimer's disease (published in the Archives of Neuorology on May 9, 2011). However, the most important psychosocial element associated with the onset of Alzheimer's disease is clearly age, with more than one in three Americans 85 years and older diagnosed with the disease. Among the additional socioeconomic and other factors that have been investigated are education, occupation, social engagement, cognitive engagement, physical activity, leisure activity, diabetes, hypertension, mid-life obesity, depression, smoking, and alcohol use. Some say that tobacco use is associated with an increased risk for Alzheimer's disease, and this association may be stronger in the presence of the apolipoprotein E4 genotype. There also may be a protective effect against Alzheimer's disease for those who have engaged in greater physical activity and have significant cognitive engagement. The effect of light to moderate alcohol intake is supported to some extent as protective against Alzheimer's disease, while lower educational level appears to be associated with increased risk. Occupation, leisure activities, and social support are believed by some investigators to be relevant factors, but additional research is needed to fully characterize their influence.
I recently heard that that an antioxidant in grapes either slowed or stopped the progression of Alzheimer’s disease. Could you tell me more about this research? [ 08/09/11 ]
Researchers believe that oxidative damage and inflammation contribute importantly to the progression of Alzheimer's disease. This has led to the use of various natural substances and medications with antioxidant and anti-inflammatory properties in research studies. Among the polyphenols that have been studied, turmeric, curcumin and grape seed extract have all been in the news recently. For example, in 2010 researchers at the Mount Sinai School of Medicine published a study of grape-seed polyphenol extract (GSPE) in the Journal of Alzheimer's Disease. They reported that mice engineered to show features of Alzheimer's disease showed reduced formation of neurofibrillary tangles (tau protein pathological changes) when they were given oral GPSE. A more recent publication by the same research group showed that GSPE reduced a specific form of beta-amyloid protein in a mouse model of Alzheimer's disease. It does not appear that GSPE has yet been studied in humans with Alzheimer's disease.
I have recently been told that coffee helps protect against Alzheimer's disease. Is this true? What research has been conducted to prove that coffee has a protective effect? [ 07/20/11 ]
This question is a timely one, because recent research into the relationship of coffee to risk for Alzheimer's disease has revealed surprising new information. Previous research has suggested that there may be a small protective effect of moderate intake (3 to 5 cups per day) of caffeinated coffee.1
Caffeine administered in drinking water was shown to reduce beta amyloid production in mice specially bred to express some brain changes associated with Alzheimer's disease. More recent research notes caffeinated coffee's newly discovered effect on Granulocyte-Colony Stimulating Factor (GCSF) protein.2 GCSF is a substance greatly decreased in patients with Alzheimer's disease. In this study, the researchers suggested that caffeine synergizes with some as yet unidentified component of coffee and may reduce the damaging effects of Alzheimer's disease by recruiting bone marrow stem cells to remove beta-amyloid protein from the brain, by increasing the formation of new brain cells, and by promoting new brain cell connections. However, it must be noted that these studies have been done in mice, not humans.
Caffeine, it must be noted, can have harmful effects when used in excess; furthermore Alzheimer's disease is a complex disorder, for which there is currently no known prevention or cure. Some research has generated hope that one day it might be possible to slow the progression of Alzheimer's disease, delay its symptoms or even prevent it from occurring at all. Although there is preliminary data to support the benefit of some interventions, such as physical activity and cardiovascular risk reduction, nothing at this time has definitively been shown to prevent Alzheimer's disease or other dementias.
1(Neuroscience 2006 Nov 3; 142(4):941-52)
2(J Alzheimers Dis. 2011 Jan 1;25(2):323-35)