At what stage is Namenda no longer effective? [ 04/25/12 ]
It would be great to know the answer to this question, since nobody wants to give Alzheimer's patients medications that aren't helping them; however, there is not a great deal of scientific information to guide physicians. Studies have shown that Namenda (memantine) improves cognition and some behavioral measures in "severe" Alzheimer's disease patients, and one study published in the Journal of the American Medical Directors Association in 2004 reported that nursing home residents who discontinued Namenda showed, as a group, worse changes in cognition and mood than a comparison group who remained on Namenda. This study also reminds us that Namenda's benefits (though they may be modest) extend beyond measures of cognition.
Is BPSD (Behavioral and Psychological Symptoms of Dementia) considered to be an Alzheimer's disease diagnosis? [ 04/24/12 ]
Current diagnostic criteria for Alzheimer's disease assess rely on the presence of cognitive but not behavioral and psychological symptoms of dementia. From the standpoint of a caregiver or clinician, though, these behavioral symptoms may create more distress than loss of memory. BPSD are usually the factors that determine when a person with dementia must move into institutional care, because it is so challenging to care at home for someone who, for example, is aggressive or tends to wander. These BPSD, incidentally, do not occur only in Alzheimer's disease—they are found in other types of dementia and in conditions other than dementia—but the majority of Alzheimer's disease patients will show them at some point in the course of the illness.
Is it possible to replace the neurons that have been destroyed by plaques and tangles? If not, then seeking a cure for Alzheimer's disease in terms of returning the person to his/her normal state of health is not possible. Once the brain cells are dead they cannot be replaced. Thus, research should focus on early identification, diagnosis, prevention, and slowing the progress of the disease. Are my comments accurate? [ 04/23/12 ]
I think you could look at this problem a little differently. Although current approaches do not "cure" Alzheimer's disease by reviving neurons, they have some symptom-alleviating effects. They could be considered palliative. But in the future, perhaps there will be therapies that allow stimulation of new brain cell growth or at least growth of new synaptic connections that compensate for the loss of destroyed neurons. I certainly agree with your view that current research should pay a lot of attention to prevention and early recognition as well as finding additional ways to reduce symptoms and, if possible, affect the course of the disease.
How can you tell if someone is showing early signs of Alzheimer’s disease? [ 02/13/12 ]
The earliest stages of Alzheimer's disease, according to the National Institute on Aging, are characterized by brain accumulation of beta amyloid without obvious behavioral or cognitive changes. The earliest cognitive changes, detectable only on careful neuropsychological testing, may be subtle changes in memory storage. When Alzheimer's disease produces actual cognitive changes, some of the first ones are non-diagnostic (that is, they could just be signs of normal aging). The affected person feels like he or she is not remembering things as well as as they used to, but nobody else notices. The next stage in progression toward Alzheimer's, is “mild cognitive impairment,” and at that point the memory difficulties start to attract others' attention. The affected person has trouble recalling words or names, performing complex tasks, remembering what he or she has read, or planning and organizing things. This usually, but not always, progresses to Alzheimer's disease, which in its mild phase is noticeable to friends and family and even to people who did not previously know the patient. Early-stage Alzheimer's disease includes more obvious cognitive changes including forgetting significant recent events, and having greater difficulty with complex tasks such as calculating the tip in a restaurant or balancing the checkbook and paying bills. Emotional changes such as those seen in depression may also be more apparent at this stage.
I am 48 years old and have had symptoms of throbbing, tension, stress, and a gripping tightness inside my head or brain for the past 25 years. The feeling is like a balloon or rubber tube trying to expand or tighten. I have consulted several psychologists and neurologists, and recently had an MRI scan. No physical problem has been diagnosed. I also have difficulties in concentration and remembering things. I would appreciate if you could advise me. [ 12/23/11 ]
Seeking an explanation of these distressing feelings for 25 years must have been an extremely frustrating experience. I don't think I can provide the definitive answer you've been looking for, but I can suggest a course of action. There are many things that can contribute to the symptoms that you have been experiencing; however, they appear to be consistent with an anxiety condition. Over the years, I'm sure you have noticed various things that make it better or worse, such as sleep, caffeine, exercise or stress, and if you haven't already done this you might make a careful list of the factors that affect your symptoms. Then, find a doctor who has expertise in treating anxiety disorders. The assessment of your symptoms will include consideration of atypical headaches, focal seizures, nutritional deficiencies, toxicities, and sleep disorders among other problems. If, after a thorough evaluation, it seems that anxiety is the most probable explanation, you may be given medication and encouragement to participate in cognitive/behavioral psychotherapy. Don't give up—there is probably a clinician who can help you feel better!
Are there any health benefits of tomato juice for someone with Alzheimer’s disease? [ 09/21/11 ]
Tomatoes contain lycopene, a carotenoid antioxidant that has been shown to fight a variety of cancers in experimental protocols. Levels of lycopene, along with levels of some other antioxidant chemicals, have been shown to be depleted in the brains of people with Alzheimer's disease. The chemical form of lycopene that appears to be most useful to the human body is more plentiful in cooked than raw tomatoes, but even if tomato juice is not the richest source for usable lycopene it is nonetheless a nutritious drink that is unlikely to cause harm.
A number of preliminary studies suggest that how we eat may raise or lower our risk of developing Alzheimer's disease. Eating a diet that is high in whole grains, fruits, vegetables and that is low in sugar and fat can reduce the incidence of many chronic diseases, and researchers are continuing to study whether these dietary modifications are also applicable to Alzheimer's disease. However, the strongest research supporting these modifications has been performed in animal studies, and remains to be rigorously established in randomized and controlled human clinical trials. Further research will provide clarification on the role of diet in the prevention and/or treatment of Alzheimer's disease.
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.