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.
How safe is aspartame? Can it cause memory loss, brain poisoning, or Alzheimer’s disease? [ 07/05/11 ]
The use of aspartame is a topic of great controversy, with strong proponents of its benefits as a low-calorie sweetener bumping heads with nutrition-oriented critics concerned about potential toxic metabolites and other alleged toxic effects. Although a link between aspartame use and memory loss, brain poisoning, or Alzheimer's disease has been suggested by some, at this point there is no convincing evidence that moderate and appropriate use is linked with these adverse outcomes.
During the last few weeks, an 85-year-old Alzheimer’s patient has been opening and closing a case that contains her deceased husband's jewelry and a box of her rings. She does this for hours. One night, she repeated this behavior for five hours. I unplugged the light by the nightstand where she keeps the jewelry, but she now uses another light. I've tried keeping her up during the day, but it doesn't work. Do you have any suggestions? [ 06/27/11 ]
A repetitive behavior such as this may reflect a variety of causes, and it's tough to figure out which are most relevant without a more detailed analysis. I wonder if this repetitive behavior reflects feelings about her husband's absence. Also, have you've tried to sit down with her and reminisce about her late husband by looking at pictures and sharing fond recollections? Perhaps that would be a way of giving her some relief from the need to interact in this way with his possessions. Other possible explanations for her behavior might include anxiety (her deceased husband's jewelry may provide a comforting effect), a manic reaction (accounting for the sleep disturbance), or just lack of other activities that might occupy her (such as a jigsaw puzzle to work on) if she experiences disrupted sleep and wants to get up during the night.