Saturday, March 29, 2008

Updates on Alzheimer's Disease

Alzheimer's Disease is of particular interest to me, since my mother-in-law has it, and my father did too in his last years, although we never had a specific diagnosis.

Those of you who follow my other blog may be aware that in February we had a family crisis of sorts. My father-in-law, who is my mother-in-law's caretaker, was suddenly stricken ill (life-threatening bleeding in his intestines from diverticulosis) and hospitalized. Since we were unable to properly care for my mother-in-law, we needed to find respite care for her until my father-in-law recovered.

We were suddenly plunged head-first into the world of caregiving, and the financial and legal issues associated with it.

With the help of the hospital's social worker, we were able to find my mother-in-law a very nice nursing home for the time-being.

Through the magic of the internet, we found a local attorney who was able to draw up a Power of Durable Attorney document for my father-in-law to sign (up until then we did not have that document, which is very important for any children of elderly parents to obtain). Without it we couldn't access his bank account or other assets to pay for anything he or my mother-in-law needed.

Then we consulted with an eldercare attorney to get direction on the best way to handle the situation going forward.

Currently my father-in-law is back home while my mother-in-law is still in the nursing home while we figure out what the next step should be. Should she stay permanently in the nursing home? Or is she still well enough to live at home, albeit with help? My father-in-law now admits that her care is too much for him, especially after his recent health problem. But if she goes permanently into a nursing home, the financial implications become problematic.

As it is, we may have waited too long to address some of these eldercare issues, because it is uncertain whether we will be able to get Power of Attorney for my mother-in-law since she may not be deemed competent to sign the document; in that case it means going to court to obtain guardianship for her - which will involve about two more months of time and a $3000 legal bill.

We also learned that because both of my in-laws' names are on the deed to their house, both of their signatures would be required to sell the house if they need to sell. If my MIL is not competent, then my father-in-law or we need guardianship so we can sign in her stead.

The reason I'm sharing all this with you is for those who may have relatives in a similar situation. I hope you will heed my tale as a warning to go get the advice and legal documents you need before an emergency arises that forces you to do it. It would be a lot less stressful that way!

The Family Caregiver Alliance contains a wealth of information on all aspects of caregiving and eldercare issues if you would like more information about this important subject.

Now, on to the news:

Researchers at Rhode Island Hospital and Brown University learned that people with early Alzheimer's Disease were involved in more crashes and performed more poorly on road tests than those without the disease.

I'm sure this comes as no surprise for those of us who have had a parent with Alzheimer's Disease. My father, never a good driver, first got lost more easily and then started hitting things fairly frequently as he began to develop dementia. When he finally had a more serious accident as a result of running a red light, we asked him to stop driving, and he agreed. Luckily no one was hurt.

My husband's grandmother, who hadn't learned to drive until her husband died when she was 70, drove safely for about 10 years until she started to lose her grip. She drove a standard shift car, and one day suddenly couldn't remember how to change gears. That was when my in-laws realized she couldn't drive any more.

If you have a loved one with early dementia and are concerned about their driving, the Caregivers Alliance link above has more information on how best to address this problem.

According to Reuters, the NYU School of Medicine has discovered that PET scans can help diagnose Alzheimer's and other dementias. PET (Positron Emission Tomography) "correctly classified 94 percent of the normal subjects, 95 percent with Alzheimer's disease, 92 percent with dementia with Lewy bodies and 94 percent with frontotemporal dementia."

One of the problems with Alzheimer's Disease in the past has been the difficulty of accurately identifying it in the patient. Because Alzheimer's Disease and other forms of dementia may need different therapies, this is an important finding that should help doctors diagnose Alzheimer's earlier and with more accuracy.

According to the reasearcher
, "'Because the incidence of these disorders is expected to increase dramatically as the baby-boom generation ages,' she added, 'accurate diagnosis becomes extremely important, particularly at the early and mild stages of dementia when life-style changes and therapeutic interventions are supposed to be most effective.'"

In other news, researchers at the University of California found that melatonin and light therapy can help Alzheimer's patients remain acclimated to the normal day and night sleep-wake cycle.

Many Alzheimer's patients tend to wake up at odd hours of the night and sleep during the day when they could be interacting with others and participating in activities.

The light therapy is similar to what is used for people with Seasonal Affective Disorder - patients are exposed to bright light for an hour or so in the morning.

For the study at the University of California, Alzheimer's patients were divided into three groups: One got only morning light therapy, one got both morning light therapy plus melatonin at bedtime, and the third group didn't have any special treatment.

It was found that only the group receiving both light therapy and melatonin improved in their daytime alertness.

Since light therapy alone did not show an effect, it is unclear whether it provided any benefit to the group that received melatonin, or whether melatonin alone was responsible for the improvement. Further research needs to be done to clarify this.

Many Alzheimer's patients are recalcitrant when it comes to taking pills and other medications. My mother-in-law is relatively good about this but sometimes she hides a pill in her mouth and spits it out when no one's looking, the same way my cat does when I give him a pill. The solution has been to crush pills in applesauce and have her consume them that way, which works as long as she's in the mood for applesauce.

Last summer, however, the FDA approved an Alzheimer's medication that is delivered in a patch. The medication, Exelon, is a drug for treating mild to moderate Alzheimer's Disease that has already been approved in the form of a capsule and an oral solution. It works similarly to Aricept, another commonly prescribed drug used for Alzheimer's Disease.

The patch, which can be applied to the back, chest or upper arm, delivers the drug in a steady dosage throughout 24 hours, after which it must be replaced with a new one.

A study showed patients using the patch had fewer side effects than with the capsule version of the drug.

Further research continues constantly, so if you have a loved one with this disease or are worried about getting it yourself, don't be discouraged. If you are interested in learning more, please check the National Institute of Neurologic Disorders website.

UPDATE: In doing some further research, I discovered that there have been studies that show Perispinal etanercept (Enbrel, Amgen), an anticytokine therapy that targets excess tumor necrosis factor - alpha (TNF-α) - in the brain, has been shown to produce almost immediate cognitive and behavioral improvement in a patient with moderate Alzheimer's Disease.

The therapy, which has already been approved for use in rheumatoid arthritis, reduces neurological inflammation. It is administered via a once-a-week injection into the cerebro-spinal system. Full research article is available at this site.

Further research must be done, but this seems to be a promising therapy.

Saturday, March 22, 2008

Medical Sabbatical

Hello fellow hypochondriacs! I just wanted to pop in and apologize for my long absence. I had been intending to write another information-laden post about, of all things, appendix cancer. (Yes, there is such a thing - and a friend of mine was recently diagnosed with it.) But I haven't had enough time and energy recently. (Do you think there's something wrong with me?)

I still want to write about that cancer, but was sidetracked for the entire month of February due to some family issues. Then I was on vacation for two and a half weeks, and have just gotten back into the swing of things. In addition, politics, my other obsession, has been taking up what time I have had for blogging, on my other site, Mauigirl's Meanderings.

I think to get back to my medical calling over here, I will write some shorter posts about recent medical developments before writing the long post. I hope to have something up in the next day or two!

In the meantime, no, that hacking cough you have is NOT lung cancer. It's from the dry heat in your house. Or the pollen that I hear is already blowing around out there despite the fact that every tree in my area is still starkly naked.

Of course, if the cough doesn't go away please do get it checked out...Just because you're a hypochondriac doesn't mean you don't have a fatal disease!