My doctor says that I have white flakes showing up in an MRI of my brain, but he did not explain further. What do the flakes mean? [ 01/06/11 ]
Your MRI may have shown 'flecks' of brighter areas on the MRI that reveal a condition called 'white matter disease.' There are many different causes of 'white matter disease,' and some are more serious than others. In older adults, disease of the small blood vessels can lead to characteristic 'white matter disease findings' on the MRI. When the small vessel disease is serious, it can be associated with cognitive changes, but the presence of mild white matter changes does not necessarily mean that severe cognitive impairment is present. Some causes of 'white matter disease' are treatable, so your doctor should discuss this finding with you further. Making the most likely diagnosis will require your doctor to consider your age and medical history as well as any current symptoms. He or she may also refer you to a neurologist for a more detailed further examination.
Is there a relationship between drinking alcohol and getting Alzheimer’s disease? [ 12/30/10 ]
A recent extensive review prepared for the Agency for Healthcare Research and Quality (www.ahrq.gov) concluded that light to moderate alcohol users benefited from a small protective effect against Alzheimer's disease. Heavier drinkers did not appear to be at greater risk than the general population; however, two important cautions should be considered:
- In cognitively impaired individuals, alcohol can have a significant influence on the ability to think and reason, and therefore someone with dementia should limit if not abstain from use of alcohol.
- Heavy alcohol use can impair cognitive function without causing Alzheimer's disease. A syndrome called "alcoholic dementia," which significantly affects memory and other cognitive functions, describes the severe effects that alcohol has in some heavy drinkers.
Alcohol consumption should always be discussed with a physician who is familiar with a patient's medical history and current medication regimen.
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Can you simplify the process of how plaques and tangles affect the brain during Alzheimer’s disease without using medical terms? Does a healthy brain have any plaques or tangles forming at all? [ 12/29/10 ]
Plaques seem to occur because an abnormal kind of protein clumps together, causes a reaction from the blood and immune system, and results in globs of dead brain cells that no longer can process information or make the body do what it should. Tangles result when the inner workings of brain cells are chemically altered, get all twisted and cannot do what they are supposed to, which is to help the cell function properly. Plaques and tangles can be seen in the brains of older adults who do have dementia, but patients with dementia due to Alzheimer's disease have lots more plaques and tangles, especially in certain parts of the brain involved with memory and other kinds of thinking.
My co-worker has had increasing difficulty with memory loss over the past 2 years. Her son has also noticed changes in her memory and advised her doctor to test for Alzheimer's disease during her last office visit. Of course, the doctor mentioned this request to his mother and she denied any problems. She feels that she has always had issues with poor memory and that these symptoms are not unusual for someone who is 76 years old. After she told me of that incident, I felt obligated to tell her that I too have noticed that she has had difficulty remembering things, and received the same response that she gave her doctor. Is there any way that her son can help her? [ 12/28/10 ]
It is common for minor cognitive changes to accompany aging, and your co-worker may be experiencing normal changes or more significant changes. Difficulty with memory can be a longstanding issue or a new problem and there are many potential causes, so Alzheimer's disease is only one of the possible explanations. Some of the conditions that interfere with memory, such as use of certain medications, can be helped relatively easily, but without evaluation the opportunity to help will be missed or inappropriate treatment may be recommended. Perhaps your co-worker can appreciate the importance of assessing her memory more formally in order to reassure everyone that the memory difficulties are normal for her age, or to make sure that a potentially harmful but treatable medical condition is not overlooked and allowed to progress. Otherwise, it may be necessary to wait until her job performance is impaired enough to require the intervention of a work supervisor to discuss this with her.
I recently read that walking can slow memory loss in people with Alzheimer's disease. Is this true? [ 12/11/10 ]
Although exercise is a readily available health-promoting intervention for many of us, it's woefully under-prescribed! Recent research indicates that walking may slow down memory loss for people with Alzheimer's disease, and may decrease the likelihood of developing dementia in older adults without cognitive impairment. A recent study presented just this past week at the annual meeting of the Radiological Society of North America in Chicago found that seniors with mild cognitive impairment or with Alzheimer's disease slowed the progression of mental decline by walking 8 kilometers each week. Other subjects, already diagnosed had a slower progression of mental decline over 5 years than those who did not. Eight kilometers is less than 5 miles and the majority of elders should be able to engage in an equivalently demanding level of exercise, an exertion well worth the effort for benefits not only on the potential benefit for cognition but also cardiovascular and metabolic health!
What are the best drugs for epilepsy and Alzheimer's disease? [ 12/10/10 ]
Seizures can occur as the primary manifestation of a disease (epilepsy) or as a complication of Alzheimer's disease. To make matters more complicated, seizures can also represent a bad reaction to certain medications or to a variety of medical conditions including such problems as electrolyte disturbances or a high fever. If an anti-seizure medication is appropriate, the clinician who prescribes it will take into account many individualized factors including the type and frequency of seizures, the probable reason they occurred, the other medications that the patient is taking (to avoid interactions), any history of allergies or adverse reactions, and the known side effects of each eligible anti-seizure medication. The best results depend on careful consideration of all these factors.
I was wondering if asking a lot of questions is one of the early symptoms of dementia. As the person loses the ability to retrieve words and thoughts to make conversation, perhaps it is easier to question rather than create original dialogue. [ 12/09/10 ]
As you point out, it's probably easier to ask than to answer, though it can be trying for the person who is asked! Many cognitively impaired people find themselves unable to remember what they have only just been told. Sometimes they don't even remember that they just asked the same question a few minutes ago. When barraged with repeated questions, it's important to keep in mind that repetitive questioning signifies memory problems and not a lack of interest in the information or the person being asked. Use of a notebook helps some cognitively impaired people hold onto information better, but as memory impairment increases reliance on a notebook may become more untrustworthy. All in all, it's probably most helpful to simply repeat the answer to the question, exercise patience, and keep in mind that it can be frustrating to have to keep asking!
My mother was diagnosed with vascular dementia 4 years ago. Last September she was moved to a new nursing home with a dedicated dementia unit. I have noticed a rapid decline since her move to this new nursing home, and I am wondering if this is just the progression of the disease or if medication could be contributing to her decline. I noticed almost immediately after moving her to the new unit and Depakote was prescribed, she was no longer able to make sense when she spoke. She is also on a very small dose of Seroquel. She has lost almost 20 pounds in the past year, but has maintained her current weight for about 4 or 5 months. Any information that you can provide is appreciated. [ 12/08/10 ]
There are multiple possible explanations for your mother's decline. For someone with dementia, accommodation to change can be difficult and she may have been stressed by the move to a new environment even if the move was necessary and to a good nursing home. Changes in her daily schedule or other aspects of her new environment may have created a routine that is frustratingly beyond her current abilities or boringly understimulating. Medications, too, can produce undesirable and unintended changes such as an increase in daytime sleepiness or confusion. Both Seroquel (the antipsychotic quetiapine) and Depakote (the antiseizure medication divalproex) have been known to help some individuals but also to produce the effects that you mention in others. The course of a dementing illness can be more rapid at times, slower at others, and may account for her symptoms. Finally, a change in medical health such as onset of a urinary tract infection is sometimes the explanation for an unexpectedly rapid clinical decline. Other medical conditions, too, can account for mental status changes and also for weight loss. Your mother is probably due for a review of her medications, living circumstances, daily schedule, and medical health status in order to assess whether changes in any of these might slow her recently accelerated decline.