IS GINKGO BILOBA OF ANY VALUE?
Recent studies have shown that Ginkgo Biloba may improve the intellectual performance of persons with Alzheimer's disease yet the results have been conflicting. Studies have been inconclusive in showing a relationship between a certain extract of Ginkgo Biloba and improvement of ongoing symptoms of the disease. The results of a multicenter research effort should be published with more definitive conclusions in the very near future. It is advisable to consult with the patient's physician before instituting vitamins or supplements, as there can be risks even with over-the-counter treatments.

WILL ALL PATIENT'S WITH DEMENTIA DEVELOP PARANOIA OR OTHER BEHAVIORAL PROBLEMS?
Some people with Alzheimer's disease or other dementias may develop behavioral or psychiatric problems such as paranoia. The caregiver should be aware that these undesirable behaviors often result from some stimulus in the environment. Noting which factors trigger undesired behaviors may help to reduce or eliminate them. Caregivers should be aware that effective communication with the patient is helpful in reducing some of those behaviors. Sometimes, a new medical condition like constipation or an infection can cause an abrupt change in behavior. Medications are available for the patient who may not respond to modifications in the environment, or communication techniques or elimination of physical causes as sources of unfavored behaviors.

HOW CAN YOU DETERMINE IF THE PERSON WITH DEMENTIA HAS PHYSICAL PROBLEMS IF THEY CAN NO LONGER COMMUNICATE?
As the disease progresses, the patient may no longer be able to verbalize discomfort to the caregiver. There may be non-verbal cues to alert the caregiver that there is a change in the patient's physical status. Often behavioral changes in the patient alert the family that there is some physical problem. For example, constipation might result in an increase in agitation, whereas an infection might result in the patient becoming more listless or lethargic.

HOW DOES ALZHEIMER'S DISEASE OR DEMENTIA CAUSE ONE'S DEATH?
Advanced Alzheimer's disease can lead to the impairment of the patients' immunological system, and this can predispose them to concurrent infections such as urinary tract infections and pulmonary infections (such as pneumonia). Coupled with the fact that as the disease progresses, the patient becomes more immobile, most dementia patients ultimately succumb to the conditions associated with immobility.

HOW DOES THE CAREGIVER DEAL WITH NERVOUSNESS AND ANXIETY THAT MAY BE ASSOCIATED WITH MEMORY LOSS?
Ideally, the caregiver should not make memory loss an issue in front of the patient. Nervousness and anxiety may result directly from brain changes, but may also be the way the patient responds to the environment that he no longer is able to fully understand. When the caregiver tries to communicate on a more simple level with the patient, comprehension may increase and frustration and agitation may decrease. Anti-anxiety medication is a last resort but is worth considering when other approaches do not solve the problems. Medication can be especially important when it can contribute to maintaining the patient in his home environment for a longer period of time.

IS ALZHEIMER'S DISEASE HEREDITARY? SHOULD WE TEST OTHER FAMILY MEMBERS?
While heredity plays a role in the development of Alzheimer's disease, the causes are probably multiple. In less than 5 % of cases, there may be a genetic link especially if the disease manifests itself in middle age. This "early onset" AD (age of onset less than 65 years of age) or "familial" AD has been attributed to genetic defects on chromosomes 1, 14, and 21. The more commonly occurring Alzheimer's disease of old age (age of onset greater than 65 years of age) has also been recently linked to a gene called Apolipoprotein E (Apo E). However, blood testing for the Apo E gene is not helpful in determining whether an individual will definitely develop the disease. The Apo E gene is considered a risk factor for the disease just like hypertension and high cholesterol levels are risk factors for cardiac disease.

CAN DEMENTIA BE FORESTALLED BY DOING LOTS OF MENTAL EXERCISES?
Studies have correlated high educational achievement with a decreased risk of developing Alzheimer's disease, suggesting that taxing one's brain throughout one's life may reduce the risk of developing the disease. Further studies are needed to develop this correlation more fully but it is felt that by doing continued mental exercises, one may increase brain reserve thereby delaying the symptoms of the disease.

WHAT DO THEY MEAN BY CAREGIVER STRESS?
Caregiver stress is the emotional response of the caregiver to the problems encountered in the day to day care of someone with Alzheimer's disease or other dementias. Stress can reduce the caregiver's ability to deal with daily routines and trouble shoot problems. Unresolved caregiver stress makes the caregiver vulnerable to various disease processes including depression. Common recommendations for dealing with stress include support groups, educational programs such as those given by the Alzheimer's Association, taking time off from caregiving, and getting sufficient rest and adequate nutrition.

IS IT SAFE FOR A PERSON WITH DEMENTIA TO DRIVE?
Driving involves critical thinking, decision making, visual spatial determinations, and reaction times that may become impaired in a patient diagnosed with dementia. Although it is a difficult decision to make, it is probably safer for the patient, his family and other motorists on the road if the patient does not drive after diagnosis. None the less, families who need more support and advice with this issue might refer to the person's physician. If necessary, the patient's physician can contact the MVB (Motor Vehicle Bureau) to revoke the person's license. Disabling the patient's automobile by removing the distributor cap can help the situation if the patient further refuses to stop driving.

HOW DO YOU GET AN OLDER RELATIVE TO ACCEPT HELP?
It is not uncommon for an older person diagnosed with dementia to refuse help in the home. It is one way for the person to retain independence, autonomy and control. Insisting on hired help to come in may result in anger, aggression, or agitation. Respecting the person's wishes but waiting for a time when they will finally allow assistance, may result in the best solution. However, if the person lives alone and has limited insight into unsafe situations, safety issues may outweigh autonomy issues. The person may have to live with a family member, a hired companion, or move into a residence with a higher level of supervision, like an assisted living facility or nursing home.

WHAT IS PRION DISEASE?
These are diseases resulting from infectious proteins, which can cause both transmissible as well as inherited diseases. Prions convert normal proteins into dangerous proteins. The prion diseases are fatal and are also known as spongiform encephalopathies as they cause the brain to develop holes. Mad cow disease is the prion disease that received a great deal of attention in Europe. Mad cow disease, which was infectious in cows, has become infectious in humans as well. Creutzfeldt-Jakob disease, Gerstmann-Straussler-Scheinker disease, and Fatal Familial Insomnia are also human prion diseases. Creutzfeldt-Jakob disease can be inherited or spread by corneal transplants, or by the use of contaminated surgical instruments. All of the above mentioned prion diseases result in dementia and other neurologic symptoms.

WHAT COMMUNITY RESOURCES ARE AVAILABLE FOR PERSONS WITH DEMENTIA AND THEIR FAMILIES?

  • There are a number of governmental agencies that can provide homemaker-housekeeper-companion service to the demented patient residing in the community.
  • Adult day care services provide a way for the patient to participate in worthwhile activities and provide some respite for the family caregiver at the same time.
  • Meals on Wheels is available in many cities, towns, and villages for patients who cannot manage to fix a nutritious meal.
  • The local chapters of the Alzheimer's Association have begun to provide support groups for early stage dementia patients. The Alzheimer's Association provides a wealth of information to caregivers about dementing illnesses, provide identification bracelets for patients through the Safe Return Program, as well as run free support groups for the caregivers.
  • Eldercare lawyers are available to assist in financial planning and estate issues. State forms designating an agent for Durable Power of Attorney for Health and for Finance are available at most local hospitals social service departments and do not often require the assistance of a lawyer to fill out.
  • Local libraries are now filled with books written for the caregiver on dementing illnesses.

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