Questions & Answers

The most recent foods to receive attention by the medical community as being potentially beneficial for protecting against cognitive decline caused by Alzheimer's disease include coconut oil (also in fresh coconut and canned coconut milk), curcumin (the yellow pigment in the curry spice called turmeric), and apple juice. Foods rich in antioxidants may also be beneficial for slowing cognitive decline. Foods considered antioxidant-rich include blackberries, blueberries, spinach, strawberries, red bell peppers, walnuts, artichoke hearts and tomatoes, among many others. Green tea, dark chocolate and red wine all contain antioxidants too. Further research is required before definitive statements can be made with regard to the efficacy of using these food products for either the prevention or treatment of Alzheimer’s disease symptoms.

Any therapy that can help to reduce stress in the patient suffering from Alzheimer's disease is also good. Physical exercise (to the best of the patient’s capability), massage or relaxation therapy, music therapy and art therapy have all been reported as being helpful to AD patients.

Another lesser known alternative therapy is doll therapy, which involves giving a lifelike doll baby or teddy bear to a dementia patient and allowing them to interact with the doll. It has been observed that dementia patients given dolls to “care for” tend to be more communicative with caregivers and staff and less prone to negative behaviors, such as agitation or anxiety. Doll therapy seems to bring out the nurturing instinct in many dementia patients, particularly females, who may be reliving memories of being a parent of an infant, a time in their lives when they were very much needed and useful.

Non-formal observations by caregivers recommend that the doll be as lifelike as possible, and be introduced to the patient while he or she is still in the early stages of the disease to allow time for bonding with the doll. Given in the later stages, the doll may be less effective.

High levels of chronic stress, an incidence of head injury, and a close family member with Alzheimer's disease are all factors that have been associated with a greater risk of developing Alzheimer's disease (AD). So based upon these aspects, your overall risk of developing AD is higher than that of a person in the general population with none of these factors. However, this does not mean that you will definitely get the disease. There are a number of other genetic and environmental factors that can influence a person’s overall risk of getting AD - some of these are known (as are the 3 noted above), and some still have yet to be determined.

On the other hand, you can take some measures to help lower your overall risk as well. For example, there is evidence to suggest that exercising your mind as well as your body can help to reduce memory loss. A healthy diet and exercise can help to reduce your risk of developing Alzheimer's disease. You should strive for diet that is low in saturated and trans fats, low in cholesterol, and high in antioxidants.

You can mentally exercise your brain by doing puzzles, word or number games, or by learning a new language, musical instrument, skill or technology - anything really that challenges the mind and really makes you think. But don't forget about your body. Physical exercise for your body is just as important because it can help to lower blood pressure, reduce body weight (or maintain a healthy weight), and decrease stress levels. Reducing stress will not only act to aid short-term memory, but can also improve overall emotional well-being, which is good for long-term cognitive health. Finally, be sure to get enough sleep. Most adults need at least 7-8 consecutive hours of sleep each night in order for memory functioning to be at its best.

Scientists have been aware for some time that electroconvulsive treatment (ECT) can promote adult neurogenesis (the formation of new brain cells or neurons) in the hippocampus, an area of the brain associated with memory. ECT has successfully been used as a treatment for patients with major depression who are non-responsive to conventional antidepressant drug therapy. Coincidentally, the hippocampus is also known to be subject to deterioration and loss of neurons caused by Alzheimer's disease (AD). Enhancing neurogenesis in general has been suggested as a therapeutic strategy for the treatment of AD. So it would seem obvious, as you suggested, to determine if ECT could be used to enhance neurogenesis in AD patients.

Surprisingly, however, there have been relatively few studies that have looked at the effects of ECT in the elderly, and in dementia patients in particular. Despite the positive effects seen in younger patients with depression, ECT has also sometimes been reported to worsen memory problems following treatment in depressed patients. Therefore, most of the studies on ECT in older persons have focused on the safety and efficacy of treatment, particularly to determine if ECT exacerbates memory deficits in older patients. When administered under optimal means, ECT has been found to be safe and relatively well-tolerated in the elderly.

A handful of studies have looked at whether or not ECT can be used to treat major depression in patients with dementia. Here too, ECT was reported to be safe and effective for the treatment of depression in dementia patients. Interestingly, these studies found that not only did ECT improve symptoms of depression in these dementia patients, but it also improved cognition. However, it was noted that about half of the patients developed short-term (1-3 days) delirium as a result of the procedure, but this side-effect did not negate the cognitive improvements observed in these patients. Unfortunately, this was a relatively small study (only about 30 patients), and there were no formal controls for comparison (such as non-depressed dementia patients or depressed age-matched non-AD patients), so it is difficult to draw many conclusions based on this report alone.

To date, there have not yet been any formal, controlled studies to directly test the hypothesis that ECT may be a potential treatment for AD. Until such research has been performed and verified, it is unlikely that ECT will be used as therapy for a non-depressed patient having AD.

The arthritis medication Enbrel® (generic name: etanercept) is a TNF-alpha antagonist (TNF-alpha is an inflammatory cytokine). Studies suggest that brain inflammation may play a role in damage due to Alzheimer's disease and TNF-alpha secreted by glial cells in the brain may contribute to this damage. In a six-month pilot study in California, scientists found that perispinal injection (administration directly into the central nervous system) of etanercept produced significant cognitive improvements in all Alzheimer's disease patients (ranging from mild- to severe-Alzheimer's disease at the start of the study). Even more recently, these same researchers found that in one patient with late-onset Alzheimer's disease, perispinal injection of etanercept (i.e., injection into the fluid surrounding the spinal cord) induced significant cognitive and behavioral improvements within a matter of minutes.

These results are certainly encouraging, but additional testing will be necessary (such as much larger clinical trials and FDA approval) before any such treatment can be offered to the general public. Because etanercept is currently not approved for the treatment of AD, you can speak to a neurologist in your area but it is unlikely that he or she will be able to authorize this line of therapy. However, in the Resources section of our website you can search for Alzheimer's clinical trials in your area that you may be able to participate in.

If your mother received anesthesia while in the hospital (such as for an operation or other procedure requiring her to be sedated) it is possible, though not proven, that this could have made the Alzheimer's disease (AD) worse. Similar instances have been reported for other AD patients who were relatively fine prior to an operation, and then were reported to have more severe symptoms following a procedure requiring anesthesia. Scientific studies have had mixed conclusions as to whether anesthesia can affect the disease or disease course, so it is not clear whether this could be the cause of your mother’s recent behavior if she did have anesthesia.

Even if your mother did not have any anesthesia while in the hospital, AD on its own can in some cases cause a patient to experience a very sudden decline in their functioning. It really depends upon the area and extent of the brain affected by the disease. Please talk to your mother’s physician about the recent changes in her condition, emphasizing that this deterioration has only happened within the last few weeks. There may be another medical reason for this, but her doctor would have to perform an examination to determine other such causes.

It is also possible that your mother is depressed, which is not uncommon for AD patients. This may explain why it takes her so long to “wake up” in the morning. Or perhaps your mother is not sleeping well at night, which may be why she wakes up disoriented and unable to function properly for some time. Again, her doctor should be consulted about this new behavior, as there could be a medical explanation apart from AD that is causing her to behave in this manner.

Constant humming (or singing, chattering, muttering, or other noise-making) has been reported in patients suffering from Alzheimer's disease and other types of dementia, but this behavior has not been formerly associated with any particular stage of the disease. Typically, patients who display this behavior are recognized as being at least in the second stage of Alzheimer’s.

About a third of Alzheimer's patients have been reported to develop a condition called myoclonus, which is similar to the sudden involuntary jerks and muscle twitches you may experience when falling asleep. The muscle spasms themselves are not painful, and if your mother already requires constant care, then they probably are not as debilitating as they would be to someone who is still mobile (i.e., muscle spasms can interfere with activities of daily living or could cause a person to fall and injure herself). Even though there are medications that can help reduce muscle spasms, there are always side effects to consider when introducing any new drug. Please consult with your mother’s physician for further advice.

Hallucinations can be caused by dementia itself, by drug interactions, or by a combination of both damage to the brain (such as is found with Alzheimer's dementia) and an adverse reaction to a drug or to combinations of drugs. A physician should be consulted to rule out drug interactions or other underlying medical ailments. Depending on the area of the brain affected by Alzheimer's, a patient may retain the bulk of their verbal capabilities until a late stage of the disease, or conversely, the patient may develop progressive difficulty in being able speak coherently or to comprehend verbal or written language. While in general the disease follows a progressively degenerative course, the specific symptoms of the disease and their severity are typically unique for each patient.