My mother is in a nursing home and has recently been passing out. She was taken to the hospital, where they performed blood work and performed a CAT scan. All of the tests came back negative. They don't know why she is passing out. Is it possible that her blood pressure is too low? [ 03/10/11 ]
Passing out, or "syncope", can result from any of a number of medical causes, and low blood pressure is certainly one of the possibilities. Passing out occurs typically when brain activity is interrupted, which can occur through oxygen deprivation (from low blood pressure, transient ischemic attacks, or cardiac arrhythmias, for example) or through electrical disorganization that occurs during a seizure. Low blood pressure itself has many causes, some of which (like dehydration) are easy to fix. A comprehensive medical work up would be necessary in order to determine the exact cause of these distressing episodes.
Medicare is telling me that I need to switch to the generic form of Aricept. I truly believe that the generic is different from the original, and I don’t want to change. Is the generic version of Aricept different from the brand? [ 03/09/11 ]
Aricept is the brand name for donepezil, and there are no studies that indicate the brand name is superior. Some patients feel that they notice a difference, however, and your prescribing physician should be able to contact your insurer to request that you get access to Aricept, which might involve a larger expense on your part. I assume that you are dealing with a "Medicare Part D" plan concerning this issue, so you may also want to consider asking for help from SHINE (Serving Health Information Needs of Elders) at 1-800-AGE-INFO in reviewing your insurance and the other available options.
Could herpes cause Alzheimer’s disease? [ 02/18/11 ]
Although current research in the causes and treatments of Alzheimer's disease (AD) have focused predominantly on other hypotheses, there is a respected researcher promoting the possible link between Herpes Simplex Virus type 1 (HSV1) and AD. Professor Ruth Itzhaki and colleagues at the University of Manchester have investigated suggestive data supporting this connection. They have pointed out that HSV1 infects most people and that it resides in their peripheral nervous systems. Professor Itzhaki's team showed that HSV1 is contained in many AD amyloid plaques and that HSV1 infection of nerve cells under experimental conditions can induce the formation of these plaques. The risk is higher in individuals who have HSV1 and the APOE4 gene, which is the gene most strongly associated with the chances of developing AD. The theory proposed by Professor Itzhaki is that neuronal death induced by HSV1 infection in elderly people with reduced immunity releases amyloid, which then contributes to the development of plaques. Further research will help to determine if there is indeed a relationship between HSV1 and the development of Alzheimer's disease.
My maternal grandmother and mother were diagnosed with Alzheimer's disease. I’m terrified of following in their footsteps, especially since I cared for both of them. When I forget something, fear overcomes me due to my experience with family members who have had this terrible disease. Is there anything else I can do? I am a retired teacher, and wonder if I should return to work or volunteer to keep my mind active? By the way, I take Aricept and Namenda under a physician’s care. [ 02/17/11 ]
In time, it may be possible to identify people at higher risk for Alzheimer's disease and to prescribe a specific preventive program for them. At this point, however, the advice for reducing the risk of Alzheimer's disease is essentially the same as the advice given for the promotion of general healthy aging. It is not clear to me why you're taking Aricept and Namenda unless you have been diagnosed with Alzheimer's disease already. You should discuss the advisability of continuing these medications with a knowledgeable clinician since neither of these medications have been shown to prevent this neurological disorder.
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. The following are some general healthy aging tips that you may wish to explore:
- Engage in physical exercise
- Eat a nutritious diet
- Exercise your mind
- Cultivate social connections
- Develop a sense of meaning in your life
- Maintain adequate sleep
- Reduce stress
- Schedule activities that you enjoy
I am 26 years old and have issues with memory loss. I would like to know if you can give me some advice about how to cope with memory gaps. Do my memory problems increase my risk of getting Alzheimer’s disease when I am older? [ 02/16/11 ]
Although some early memory loss symptoms have been linked with an increased risk of developing dementia later in life, the odds at your age favor a less alarming explanation. Memory loss symptoms in a normal 26 year old suggest the effects of any one (or a combination) of potentially remediable influences. For example, if you were tested by a neuropsychologist, you may learn that your sense of cognitive difficulty represents a "subjective memory impairment," not supported by the objective results of testing. That's not uncommon among younger adults who are stressed, anxious, depressed, sleep deprived, or who are affected by medical illnesses, medications, too much use of alcohol or other recreational drugs, or other lifestyle factors that undermine optimal mental functioning. Your primary care clinician may be the person to start investigating this with you, or you may want to consult a more specialized clinician. Either way, there is plenty of hope for improvement in the present and probably little reason to be concerned about an increased risk of Alzheimer's disease when you are older.
My wife often talks in her sleep. When she wakes up she does not know where she is, and wants to go home. What can I do? [ 02/16/11 ]
When your wife awakens and questions where she is, as much as possible try to reassure her that she is safe, that she is in her home, and that you are there with her. It may seem trivial and obvious to you, but gentle reassurances such as these can greatly help to reduce anxiety and fear when a dementia patient becomes confused. After reassuring your wife that you love her and that all is well, you can also try redirecting her attention to another activity or topic, or else try soothing her back to sleep if possible.
Asking to “go home” is also a fairly common request for Alzheimer's disease patients. This request can mean that they might feel anxious or fearful of something or else they feel compelled to fulfill some obligation or task, something they remember from their past. She might, for example, be referring to a home from her youth, or perhaps her first home as an adult. She might think that she still has responsibilities to perform there, or else that was a place she felt needed and safe. Try asking your wife questions about her “home” the next time she brings it up. Ask her what she misses most about her home, what she likes best about it, or who might be waiting for her there, etc. This might give you some insight into why she feels the need to return home.
What medication options are best for a patient with Alzheimer’s disease who is anxious every day? She tried Lexapro, but it was not effective to deal with the anxiety, and caused suicidal ideation. We don't want her to sleep all of the time, but her husband needs a break and some rest. In the evenings she is unable to enjoy TV or relax, and ‘sundowning’ sometimes lasts all day. She may express an understanding that her bed is right there, but she still begs to "go home to her original city.” Bedtime is difficult to keep at a regular time as she tends to nap in the chair waiting for her time to go to sleep. She did not tolerate Ambien very well, and the effectiveness of Tylenol PM has worn off. She does not even take Aricept or Namenda any longer because they did help with her cognition. We prefer not to overmedicate her, but would like to know if there are anti-anxiety medication options that might help. [ 02/05/11 ]
Treatment of anxiety symptoms in Alzheimer's disease patients can be truly challenging because there are so many different causes of anxiety. Before trying an anti-anxiety medication, it's important to consider some of these causes and how they might be addressed behaviorally. Consider whether she may be in pain from constipation, a urinary tract infection, sores, joint pains, or other sources. Is she bored or feeling under-stimulated?
Even if she's unable to understand and enjoy television she may be able still to get pleasure from taking a little walk, listening to her favorite music, doing a very simple puzzle (for example with 25 pieces or fewer), watching a video tape of loved family members reminiscing, or enjoying a massage of her hands with lavender oil or lemon balm. Scheduling enjoyable activities at the times when she might otherwise tend to nap could improve her ability to sleep at night, though sleep continuity is typically impaired in patients with Alzheimer's disease and both daytime napping and nighttime wakefulness are common.
Concerning medications, many patients discontinue Namenda once it appears to no longer help with cognition, but some evidence supports its benefits in reducing agitation nonetheless. Tylenol PM includes components that may help some individuals increase sedation or even confusion, so its use must be evaluated individually. A geriatric psychiatrist can help you consider the potential value of other anti-anxiety medications such as buspirone, trazodone, an antipsychotic medication, or an anti-seizure medication; however, each of these medication categories has potential side effects that may accompany their possible benefits.
I am 64 years old, and the youngest in a family of eight. I have two sisters diagnosed with Alzheimer’s disease, and would like to know if there is anything I can do to avoid getting this brain disorder? I presently have an active gym program and I’m involved with book keeping. Also, does taking a daily aspirin help decrease the risk of developing this brain disorder? [ 02/03/11 ]
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.
At this point, the advice for maintaining healthy physical and cognitive health is essentially the same as the advice given for the promotion of healthy aging in general. You should keep up your gym program, book keeping, and pay attention to diet and other lifestyle factors as well. Studies on the effects of physical exercise indicate that it is beneficial for cognitive as well as physical health. Aerobic exercise is excellent and resistance training also useful. A Mediterranean-type diet that is high in fiber, vegetables, and healthy oils; and low in saturated fats and simple sugars also has been associated with healthier cognitive aging. Other data support the importance of adequate sleep, stress reduction, cognitive stimulation, and maintaining a sense of social connection and purpose.
A daily aspirin, while likely beneficial in prevention of some other disorders, has unfortunately not been shown helpful in preventing Alzheimer's disease.