Questions & Answers

Both Alzheimer's disease and Parkinson’s disease are neurodegenerative diseases, meaning that over time, a person’s symptoms will gradually worsen. Parkinson’s disease primarily affects muscle control and coordination, whereas Alzheimer's disease mainly affects memory and cognition. Therefore, it is not uncommon for patients having either disease (or both, as in the case of your wife), to develop speech and movement problems, including losing the ability to talk and difficultly with walking.

Regular exposure to sunlight can help to improve an Alzheimer's patient’s overall mood and – when combined with calming, dim lighting in the evening – can help to keep a patient’s circadian clock on track. This internal clock frequently becomes disrupted in Alzheimer's patients, such that they end up being awake at night and sleeping during the day. The long and often sunless winter months experienced in more northerly climates can also sometimes lead to a condition called Seasonal Affective Disorder (SAD). Since Alzheimer's patients are more prone to develop depression than non-AD persons, dreary winters might affect the mood of these patients and increase the risk for depression. Although no study has formally tested whether living in a sunnier climate is better for an AD patient than living in an area with less sunshine, particularly during the long and dark winter months, it would appear that there might be a small benefit to living in a place where the sun always shines.

Regarding your second question, one study in the UK found that exposure to second hand smoke is associated with increased odds of cognitive impairment in adults. Cognitive impairment in persons over 50 is often considered an early indicator of dementia. And a recent study also reports that adults exposed to high levels of second hand smoke and having indicators of cardiovascular disease run a higher risk of developing dementia. Additionally, numerous studies in children and infants have found that exposure to second hand smoke impairs memory and cognitive development. So although no studies have looked at the effects of second hand smoke on the memory of patients already suffering from dementia or Alzheimer's disease, it stands to reason that these patients would be similarly affected.

The drug Adderall is a stimulant that has been used in adolescents with attention deficit hyperactivity disorder (ADHD) to enhance attention. To date, however, there have been no formal studies that have explored the use of Adderall in dementia patients. There is little to no indication in the medical literature that amphetamine stimulants such as Adderall could be useful for treating dementia. On the other hand, the drug donepezil (Aricept), which is an acetylcholinesterase inhibitor that can help to improve cognition and attention in Alzheimer's disease patients, has been investigated as a possible treatment for ADHD.

Accusations of thievery are fairly common in Alzheimer's patients. Because their short-term memory is impaired, patients often forget where they have placed items and believe that an item has been stolen when it cannot be found. Calmly reassure your mother that none of her items have been taken. She may be anxious or agitated about something completely unrelated to the items she has lost, and her behavior is a result of her anxiety. She may, for example, not be adjusted to her new environment. Or she may feel anxious about being "alone" in a care facility or being a burden to you. She needs your reassurance that both she and her possessions are safe, that she is not a burden, and that both you and the home will take good care of her in the future. If she becomes insistent, do not argue with her about the items as this will only cause her to become more agitated. Instead, you can try to address the underlying emotion and calmly redirect her attention to a new topic. Sometimes an empathetic approach will help to reduce her anxiety by shifting her attention to a more calming subject.

In general, immune system function has been found to decline with age. Scientists now know that the immune system also plays a role in Alzheimer's disease (AD), wherein there is evidence of inflammation and immune activation associated with amyloid deposits in the brains of AD patients. To counteract this pro-inflammatory response in the brain, the body will often respond by suppressing its own immunity systemically (that is, the rest of the immune system will be suppressed due to brain inflammation). Additionally, it is recognized that the incidence of both pneumonia and urinary tract infections is increased in patients having suppressed immune responses. Therefore, the changes in the immune system caused by AD (or just by normal aging) can make patients more prone to developing secondary illnesses such as infections.

Researchers have also determined that stroke can lead to immunodepression, which increases the risk of post-stroke infections. Taken together, therefore, an AD patient who suffers a stroke would likely have an increased susceptibility to infection.

It is not uncommon for Alzheimer's disease patients to lose weight in general, particularly if they lose interest in food and eating. I would guess that your mother’s overall physical activity level has lessened as a result of the disease, and therefore her appetite may have naturally decreased in response to her body’s reduced need for energy. If, however, you believe your mother has relatively the same caloric intake as she has always had but is still losing weight, then it may be best to speak to her doctor. The doctor may suggest nutritional supplements, such as liquid supplemental nutrition drinks which would be easy for your mother to swallow. The doctor may also want to evaluate your mother to rule out if another medical condition (besides the dementia) may be causing her weight loss. Alternatively, her doctor may refer you and your mother to a registered dietician who specializes in nutrition for the elderly. The dietician can help to assess your mother’s condition and diet and can provide suggestions for her specific needs.

In the meantime, continue to serve your mother nutritious meals—mashing the food first makes no difference nutritionally speaking, and if it helps her to swallow her food, all the more reason to do it. You can also try using more sauces and gravies, which can help “drier” foods to be swallowed easier. However, unless you prepare your own sauces and gravies, be sure to read the nutrition labels on commercially-prepared ones as they can often be loaded with high levels of sodium and/or trans-fats.

Patients in the end stages of Alzheimer's disease often decrease their food intake, lose weight, decrease (or stop) physical activity and become bedridden, and generally become non-communicative. How long a person continues in this stage really depends on whether they continue to eat and drink. Once your mother reaches a point when she stops eating and drinking, and assuming she does not have a living will, then unless measures are taken to ensure she is obtaining nutrients and fluid (such as by hand-feeding if possible or—if it is her wish or your family’s decision—a feeding tube), it would not take long before dehydration would cause eventual death.

Constant noise-making, such as whistling, humming, singing, chattering, or muttering, is not uncommon in patients suffering from Alzheimer's disease and other types of dementia. As the disease progresses, it is likely your husband will eventually stop this behavior, possibly to be replaced by another such symptom. In the meantime, try to stay tolerant and remember that he would not constantly whistle if he could control his behavior better. Although it may seem maddening to you now, there will come a time when you will appreciate your husband’s ability to communicate—even if it is only by whistling.

Chewing gum could help as it might keep his mouth distracted. Just make sure that he does not have any teeth or jaw problems that could be aggravated by the constant chewing action, or any swallowing difficulties such that the gum could present a choking hazard. Also be sure to give him sugar-free gum.

Previous studies using a rat model of Alzheimer's disease indicated that the active compounds found in marijuana, called cannabinoids, could protect the rats from the damaging effects of amyloid deposits in the brain. A synthetic cannabinoid called delta-9-tetrahydrocannabinol, or THC, was given to the rats and was found to reduce the toxicity of amyloid plaques as well as promote neurogenesis (the growth of new neurons) in the brains of the rats.

Hoping to reproduce these findings, investigators at the University of British Columbia and Vancouver Coastal Health Research Institute recently re-tested the hypothesis using a different animal model of Alzheimer's disease (AD). The transgenic mice used in these studies carry human genetic mutations associated with AD and develop pathology more similar to that which is seen in human AD patients.

Thus, the mice represent a more accurate model of the disease. Using two different doses of a synthetic cannabinoid called HU210 (which is many times more potent than the naturally-occurring cannabinoids found in marijuana), the mice were treated for several weeks and then assessed on memory and final brain pathology. Unfortunately, the researchers found no beneficial effect whatsoever for mice treated with HU210, and in fact there seemed to be a slight worsening of their condition. For example, the mice given the lower dose of HU210 had worse memory test scores than non-treated control mice, and the mice given the higher dose had slightly fewer neurons overall than control mice. Additionally, there was no difference in the number or extent of amyloid plaques between treated and untreated mice, regardless of the dose of drug administered.

The researchers therefore indicated that additional studies would need to be performed before much hope could be placed on using medical marijuana as a potential treatment for—or preventative measure against—Alzheimer's disease.