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)
I recently read that there is a new drug called angiotensin receptor blocker (ARB) that fights Alzheimer's disease. Please tell me more about this drug. Is it available in prescription form? [ 07/14/11 ]
Angiotensin receptor blockers (ARBs) have been in common use for the treatment of hypertension for some years. The most familiar of these are losartan (Cozaar), irbesartan (Avapro), olmesartan (Benicar), candesartan (Atacand), valsartan (Diovan), and telmisartan (Micardis). They all are thought to work by blocking the activation of angiotensin II AT1 receptors, which results in vasodilation, reduced vasopressin secretion, reduced production and secretion of aldosterone, and other effects. Some studies, but not all, have found decreased rates for development and progression of Alzheimer's disease in people taking ARBs for high blood pressure. Its effect on Alzheimer's prevention or delay might be independent of its effect on blood pressure, since its use has also been shown to lower beta amyloid, among other effects.
Why is it better to give Alzheimer’s disease patients medications to delay the disease? [ 07/05/11 ]
Now that we recognize Alzheimer's disease to include a prolonged pre-symptomatic phase during which a destructive disease process is progressing silently, it's very clear that we should attempt to delay the course of the disease during the early stages and prolong the experience of a healthy life. In the late stages of Alzheimer's disease, however, the question of whether to delay progression becomes a profound and complex consideration. In advanced dementia, designated health care representatives are called upon to interpret and implement the presumed wishes of an affected person who may no longer be living what many of us would consider a life of acceptable quality. In my clinical practice, however, I have frequently known mildly, moderately, and even some severely demented adults to enjoy a seemingly good quality of life, highly dependent upon others for basic everyday functions but capable of mutually rewarding social interactions and pleasure. The decision to prolong life despite significant and likely progressive medical compromise is a complicated process that should be anticipated by each of us and, if possible, made clear in advance to those who will be designated as future health care representatives and tasked with making difficult decisions on behalf of us when we are unable.