Alzheimer's Disease: Questions and Answers
Print out these questions and answers to discuss with your health care provider.
1. Are there any medications that someone with Alzheimer's disease should avoid?
A person with Alzheimer's disease may be taking medicines to treat symptoms of the disease, as well as other health problems. However, when a person takes many medications there is an increased risk of having an adverse reaction, including confusion, agitation, sleepiness, or sleeplessness, mood swings, memory problems and/or stomach upset.
While it may become necessary for a person to take medicine to treat the behavioral symptoms that sometimes occur in Alzheimer's disease — such as hallucinations or aggressive behavior — some of these medications can worsen other symptoms of the disease. For example:
- Some drugs such as tranquilizers can cause confusion, increased memory impairment, and slowed reactions, which can lead to falls.
- Certain medicines to treat depression, particularly amitriptyline (Elavil®), can cause sedation. These drugs also can react with medicines used to treat Alzheimer's disease, including donepezil (Aricept®), rivastigmine (Exelon®), and galantamine (Razadyne®).
- Some medicine used to treat hallucinations can cause sedation, confusion, and drops in blood pressure. They also can react with medicines used to treat Alzheimer's disease.
It is important to discuss the pros and cons of these treatment options with your doctor before making a decision regarding medication. In addition, it is important to consider the possible side effects of over-the-counter medication, including cough and cold remedies, and sleep medicines. These drugs may also react with other medications taken by the person with Alzheimer's disease. It is best to consult your doctor before using any over-the-counter medication.
2. I'm thinking about taking a trip with my father, who has Alzheimer's disease. Is there anything special I should do?
The most important things to do when traveling with someone with Alzheimer's disease are to plan ahead and try to anticipate the person's needs, so you'll be ready for any changes or problems. As you plan, be sure to consider the stage of the person's illness and any behaviors that may be affected by traveling away from home. You may want to try taking a short trip to see how your loved one reacts to traveling. Here are a few other tips to consider:
- Plan some activities for the person with Alzheimer's disease to do when traveling. Simple things — such as reading a magazine, playing with a deck of cards, or listening to music — can help keep your loved one calm when traveling.
- Never leave a person with dementia alone in a car. When moving, be sure to keep the seat belt buckled and the doors locked.
- Plan regular rest stops.
- Bring an extra driver if your trip involves more than six hours of driving time.
- If the person becomes agitated while traveling in a car, stop at the first available place. Don't try to calm the person while driving.
- Consider planning your vacation at a place that is familiar to the person with Alzheimer's disease — for example, at a lake cabin that he or she has visited in the past.
- If your loved one is easily agitated, it may be wise to avoid places that are very crowded. You may also want to avoid fast-paced sightseeing trips.
- If your loved one has never been on a plane, it may be wise to consider driving, if possible.
- Alert the airlines and hotel staff that you are traveling with a person who is memory impaired and make sure the person is carrying or wearing some sort of identification.
- Don't forget that your caregiving responsibilities continue even though you are on vacation. It may help to bring someone along who can help you with these duties.
- Do not allow the person to go out alone at night. People with Alzheimer's disease are more easily disoriented at night; be sure they cannot wander from hotel rooms.
3. I'm having trouble getting my loved one to eat. What can I do?
Good nutrition is important for people with Alzheimer's disease. In fact, poor nutrition can worsen some symptoms of dementia. Loss of appetite is common in Alzheimer's disease; loss of appetite can also occur with commonly used treatments for Alzheimer's disease. To get your loved one to eat, try some of the following:
- Talk to your loved one's doctor. Sometimes, poor appetite is due to depression, or other treatable problems.
- Don't force feed. Try to encourage the person to eat, and try to find out why they don't want to eat.
- Avoid serving non-nutritious beverages such as black coffee and tea.
- Try to get your loved one to eat more protein and fat and less simple sugars.
- Offer small, frequent meals and snacks.
- Encourage your loved one to walk or participate in other types of light activity to stimulate appetite.
- Consider serving finger foods that are easy for the person to handle and eat.
- Remember to treat the person as an adult, not a child. Don't punish the person for not eating.
- Serve foods your loved one likes to eat.
- Serve beverages after a meal instead of before or during a meal so your loved one doesn't feel full before beginning to eat.
- Plan meals to include your loved one's favorite foods.
- Try getting your loved one to eat the high-calorie foods in the meal first.
- Use your imagination to increase the variety of food you're serving. Prepare meals that offer a variety of textures, colors and temperatures.
- Don't serve foods that provide little or no nutritional value, such as potato chips, candy bars, colas, and other snack foods.
- Choose high-protein and high-calorie snacks.
- Fruits are good snacks.
- Make food preparation an easy task: choose foods that are easy to prepare and eat.
- Make eating a pleasurable experience, not a chore; for example, liven up your meals by using colorful place settings and/or play background music during meals.
- Try not to let your loved one eat alone. If you are unable to eat with your loved one, invite a guest to share their meal.
- Use colorful garnishes such as parsley and red or yellow peppers to make food look more appealing.
4. My mother has Alzheimer's disease, and I've noticed she is getting more confused. How can I help her?
There are several things you can try to help a person who is confused:
- Try to minimize any changes in the surroundings or to your loved one's daily routine. If you have to make changes in routines, do so gradually.
- Follow simple routines and avoid situations that require the person with Alzheimer's disease to make decisions.
- Help your loved one maintain his or her orientation by describing the events for the day, reminding him or her of the date, day, time, place, etc., and repeating the names of the people with whom he or she has contact.
- Try placing large labels (with words or pictures) on drawers and shelves to identify their contents.
- Simplify or re-word your statements or requests if the person doesn't seem to understand.
- Make certain that medications are being taken regularly and at the right times.
- Provide a nutritious diet and encourage your loved one to exercise, if he or she is able.
- Be patient and supportive.
- See your doctor; medication may help.
5. Is there anything I can do to help my mother preserve what memory she has left?
Losing cherished memories is one of the devastating consequences of Alzheimer's disease. Some medications used to treat Alzheimer's disease may help slow down memory loss and there are some techniques you can use to help enhance what memory exists.
- Use notes, lists, memos, etc., to help remind the person with Alzheimer's disease of his or her daily tasks.
- Keep photos of family members and friends where the person can see them. Label photos with names, if necessary. Reminisce with him or her about the family, or activities he or she once enjoyed.
- Review family photo albums and encourage reminiscing about the people shown.
- Use memory "tricks;" for example, thinking of the word HOMES to remember the great lakes: Huron, Ontario, Michigan, Erie and Superior.
- Use labels (with words or pictures) placed on drawers and shelves to identify their contents.
- Limit your loved one's alcohol consumption and try to ensure he or she gets adequate sleep.
- Remind him or her of the date, day, time, place, etc., and repeat the names of the people with whom he or she has contact.
- Encourage your loved one to exercise his or her mind by reading, doing puzzles, writing, etc., as well as to exercise his or her body as appropriate. However, avoid challenging your loved one to the point of frustration.
6. Can ginkgo biloba cure Alzheimer's disease?
A recent carefully controlled study of ginkgo biloba in Alzheimer disease showed no significant benefit of the drug in preventing or treating memory loss. Some questions remained unanswered, and the issue cannot be considered closed.
7. Is exercise recommended for someone with Alzheimer's disease?
Exercise offers many benefits for people with Alzheimer's disease. The major benefits include improved strength, endurance, and heart fitness. Exercise can also increase energy, and improve mood and sleep. Exercise also helps people with Alzheimer's disease preserve motor skills and improve balance, which in turn, can help prevent serious injury from falls. Further, exercise can help improve mental function.
The type and intensity of exercise appropriate for someone with Alzheimer's disease depends on the person's degree of impairment. People in the early stages of the disease may enjoy exercises such as walking, bowling, dancing, golf, and swimming, although supervision may be necessary. Greater supervision may be required as the disease progresses. Activities that could lead to injury should be avoided.
It is important to talk to the person's doctor before beginning any exercise program. There may be other factors — such as bone disease, a heart condition, or balance problems — that could limit or restrict activity.
8. What is "sundown syndrome?"
Sundown syndrome — also called sundowning or sunsetting — is a behavior common in people with Alzheimer's disease. It describes the confusion, anxiety, agitation, or disorientation that often occur at dusk and into the evening hours. The episodes may last a few hours or throughout the night.
While the exact cause of sundown syndrome is not known, experts believe there are several contributing factors. These include physical and mental exhaustion (after a long day), and a shift in the "internal body clock" caused by the change from daylight to dark. Some people with Alzheimer's disease have trouble sleeping at night, which may contribute to their disorientation. Medication that can cause agitation or confusion also may contribute to this syndrome.
Sundown syndrome can be draining for the person with Alzheimer's disease and his or her caregivers. Here are some suggestions for helping a loved one with sundown syndrome cope:
- Schedule the day so that the more difficult tasks are done early in the day, when the person is less likely to become agitated.
- Watch the person's diet and eating habits. Restrict sweets and drinks with caffeine to the morning hours. Try serving the person a late afternoon snack or early dinner.
- To help the person relax, try decaffeinated herbal tea or warm milk.
- Keep the house or room well lit. Close the drapes before the sun goes down so that the person doesn't watch it become dark outside.
- If the person falls asleep on the sofa or in a chair, let him or her stay there. Don't wake the person to go to bed.
- Try distracting the person with activities he or she enjoys. Soothing music or a favorite video may help, as well.
- Encourage the person to engage in some physical activity — such as walking, if able — during the day. This may help him or her to sleep better at night.
9. When will the new Alzheimer's disease vaccine be available?
Several types of vaccines are being studied and may be available in clinical trials. They are several years away from approval.
10. Does the desire for sex diminish or totally disappear in people with early or mid-stage Alzheimer's disease?
Sexuality has been little studied in Alzheimer's disease. However, many individuals with Alzheimer's disease have mood disorders such as depression, which can cause sexual problems. In addition, medications used to treat depression can also cause sexual problems. Many persons with dementia also have decreased motivation that affects much of their lives, such as their interest in their appearance, clothes, friends, etc., and may affect their sexual function as well. A few have increased sexual drive.
If you are concerned about your partner's sexuality, try the following recommendations:
- Have your loved one's doctor assess the presence of a mood sickness, which may cause sexual problems.
- Make sure your loved one's medical problems are managed properly. For example, if they have pain from arthritis, make sure they are treated.
- Have your loved one's doctor review each medication for its possible effect on sexuality.
11. Is Alzheimer's disease inherited?
Yes, there are important genetic influences in Alzheimer's disease. Early-onset (before age 65) Alzheimer's disease has a genetic predisposition. The lifetime risk of getting Alzheimer's is estimated at between 10 and 12 percent. So an average person living to 75 or 80 has about a one in 10 chance of getting Alzheimer's. Having a family member or a close relative with the disease increases that risk two-fold.
Mutations in one of three genes that can be inherited from parents seem to explain many causes of early-onset Alzheimer's. These genes are APP, PSEN1, and PSEN2. An alteration of any of these genes leads to excess production of amyloid beta peptide in the brain, which accumulates to form the amyloid plaques in the brain that are characteristic of Alzheimer's disease.
Early-onset Alzheimer's disease is much rarer than late-onset Alzheimer's disease. The cause of late-onset Alzheimer's disease (after age 65) is not entirely clear but variants in the ApoE gene are implicated, along with lifestyle and environmental factors. Inheriting one copy of the ApoE gene variant increases the risk of late-onset Alzheimer's, inheriting two copies further increases the risk.
More recently, several other gene variants have been identified as possible risk factors for late-onset Alzheimer's disease. These are variants of the genes CR1, CLU, PICALM, BIN1, EPHA1, MS4A, CD2AP, and CD3. Some of these genes play roles in inflammation, lipid transport, and the movement of proteins within cells, which could be important pathways for development of Alzheimer's.
In most cases of late-onset Alzheimer's, however, the major risk factor is older age. After age 75, the risk of Alzheimer's disease increases substantially.
12. What can I do to avoid Alzheimer's disease?
You can take several steps to reduce your risk of getting Alzheimer's, even if you inherit the genes responsible for the disease. Some of the risk factors for cardiovascular disease also increase the risk of developing Alzheimer's. Therefore, physical activity and maintaining a healthy weight, blood pressure, and cholesterol level, as well as avoiding diabetes, can go a long way to prevent the disease. People who have diets that contain a lot of fish, vegetables, and fruits as opposed to red meat, processed meat, fat, and sugar also have a lower incidence of Alzheimer's disease. Higher levels of education appear to reduce the likelihood of later development of Alzheimer's.