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.


Will "take no prisoners" Hart said...

Isn't there a study that shows that nuns, as a group, don't get Alzheimer's (or virtually never)? It has something to do with their disciplined mental approach to life or something. I mean, it does make sense, in that "they" say an active utilization of one's faculties contributes to lessened dementia down the road.

Mauigirl said...

That does make sense, as I know that more highly educated people are less prone to Alzheimer's, or when they do get it they get it later, as they have more brain to "fall back" on.

I do know there was a study of nuns where they compared the letters they wrote when they applied to be novitiates way back when they were young, and then followed up on which ones had Alzheimer's. They found the nuns that had the less complex language and wording in their original letters were more apt to have Alzheimer's later in life. It may be part of the education thing.

Will "take no prisoners" Hart said...

Just to let you know, I'm a recreation therapist in a convalescent home and work a lot with dementia residents. I've kind of become the "cognitive guy" over there (i.e., I do a lot of cognitive skills training). I do a lot with dichotomies (good-evil, ugly-beautiful, smart-stupid, cheap-expensive, normal-unusual, relaxing-stressful, legal-against the law, valuable-worthless, safe-unsafe, friend-enemy, life threatening-not life threatening, and, of course, true-false), comparisons (what costs more?, who's stronger?, etc.), sequencing (who/what came first?), and preferences. It's a lot of fun and, hopefully, it slows down the progression of the disease (not just cognitively but overall). Do you know of any studies along these lines?

Mauigirl said...

Will, that therapy sounds very interesting, and I'm sure that it is helpful to your patients. Anything that keeps their minds active and practices thinking probably keeps them sharper. I was doing some quick searches on this therapy and although I didn't find it specifically, I did find more references to keeping the mind mentally active being helpful.

I also found an article that shows Amgen may be helpful when administered via injection form to Alzheimer's patients so I added that to my post! I may look into it for my MIL!

Will "take no prisoners" Hart said...

I just wanted to let you know about a new program I unveiled today. I called it "success or failure?". Some of the examples I came up with are; Ernest Hemingway's attempt to stop drinking, the Road-Runner's attempt to avoid capture (and certain death) by Wil E. Coyote, Floyd Patterson's rematch with Sonny Liston, Olivier's portrayal of Hamlet in 1948. Worked out pretty good in that it stimulated not just conversation but laughter, too. The best medicine, right?

libhom said...

Sorry that you are having to deal with all of this.

Mauigirl said...

Take No Prisoners, that sounds like an interesting and fun therapy!

Libhom, thanks for your comment. It's never easy with this type of situation and sadly, more and more of us are going to be going through it as our parents and other relatives age.

Jenny said...

Thanks for sharing your story. I just hope that everyone who was able to read this realize the importance of health care plans. I mean getting sick, especially for seniors, is almost inevitable. Sometimes, things just happen so suddenly that everyone in the family is left shocked or surprised. More often than not, family members are at a loss where to get the funds needed to cover sudden medical costs. This is where health care plans become handy.
All of us must think ahead for our health while we still can.

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Stephanie Warner said...

This is a great write up, I was also a victim, having Alzheimer's disease for many years. My journey and diagnosis with Alzheimer's disease began when I was 58 years old. My medical condition was heart broken. The first thing I did was get myself informed. I was subjected to different medications including Donepezil, galantamine, by my doctors for treatment without the assurance of having a positive improvement. Despite my visit to several doctors my health wasn't getting better. Also I keep thinking there has to be another alternative to address this, using herbal remedy, this information reinforced my original gut feelings that I should not give up. I decided to look for another option to help my condition. I’ve made many lifelong friends when I was looking for a natural cure for my ailment. To say it gets better is an understatement. I find hope in the darkest of days when I saw a testimony of people talking about Dr. Charanjit's herbal product. I started having series of thoughts, thereafter I ordered his product and started using it, to give the Alzheimer's disease an aggressive approach, the symptoms progressively got better.
Luckily, everything seemed to be okay after a few weeks of starting the herbs, this was a pleasant surprise. I promised myself that I would stay strong. You sit living in fear of the reality what you may face, never really knowing what will happen until it does. I am indebted and decided to always share my experience.
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Donna Tuscano said...

I suffered from this horrible sydrome (ALZHEIMER'S DISEASE)...and it was horrible...for the past 3 years this has taken over pretty much all of my walking moments along with other medical issues. My family/friends have been with me through it all. But Today I am 107 days pain free!! I can't even believe how this all happended...I am just as amazed as, my family/friends are...none of us can believe how long I suffered and now in literally a matter of 107 days I was completely pain free.
How? Well let me tell you.....Months ago my Friend told me about something called ZOMO HERBS....I heard him, but I didn't listen.....I went on just suffering along, Then My friend Raval, talked to my wife about it one night, when I was at my lowest point.....just wanting to give up...this wasn't the way I wanted to live...always in constant pain..Raval said, I will send you ZOMO HERBS..... I started using it and the rest is history my friends, There was a light at the end of the Tunnel... The results were immediate, it did take my pain away, but not was not until I upped the dosage to 3 times daily that I saw complete results.....NO PAIN.....I became so thrilled over the results that I decide to share my testimony.....If I can help even one person and that person helps one person and so on...we can all be out of pain and regaining our lives back....sound good? I have my life back!!!! I want you to have yours back too! Simply try to reach the doctor on ( for more information about his treatment process or how to get his medicine.

Carrie Kayla Reynolds said...

In my own case it was just over four years ago when my Mum began to sound different on the phone. She lived back East with my siblings and my husband and I were living on the West coast and in phone calls it became apparent that my Mum's voice no longer had the same tones of excitement and humor that she used to; and instead it was very flat. At the same time she began to tell us about a situation at work that just didn't seem possible; she was complaining that a group of fellow workers were conspiring to get her. Although Mum had much academic success as a teenager, her behavior had become increasingly odd during the past years. She quit seeing her friends and no longer seemed to care about her appearance or social pursuits. She began wearing the same clothes each day and seldom bathed. She lived with several family members but rarely spoke to any of us. Obviously this whole story seemed very unbelievable and we sensed something was wrong but had no clue as to what it could be. We recommended that my Mum quit her job and look for something else - as we began to wonder if she had a "mental breakdown" and would get better once out of the stressful job situation.
In the case of Mum, she was having persecurtory delusions, auditory hallucinations and negative symptoms that had lasted for at least Three years. All of these symptoms fit with a diagnosis of Dementia. Her story reflects a common case, in which a high-functioning young adult goes through a major decline in day-to-day skills. Although family and friends may feel this is a loss of the person they knew, the illness can be treated and a good outcome is possible as it all got better when we started using a herbal medicine for her through Aparajita.
My recommendation to people who are either wondering if they have Dementia or wondering if a friend or loved one has Dementia should contact I think one of our key problems was that we didn't do this in the early days of my Mum's illness as we never thought of a natural alternative for her.