Questions & Answers

Traveling with an Alzheimer's patient can be challenging, but you can greatly reduce stress for both you and your mother if you are well-prepared for you trip. The following are some suggestions that may help:

• Well in advance, make your aunt aware of any special requirements your mother may have. Have a quiet room waiting for her arrival.
  
  
• Try to keep to your regular schedule as much as possible while traveling - try to keep mealtimes, naps, and bedtime the same.
  
  
• If your mother is not accustomed to flying, drive instead.
  
  
• If she is okay with flying, avoid flights with stopovers - even if a direct flight costs more, it is well worth it to avoid aggravation and stress.
  
  
• Try not to travel more than 4-5 hours a day. Stop and rest if you mother should become agitated - particularly so if you are driving!
  
  
• If traveling during the holidays, try to avoid traveling on peak travel days (Christmas Eve, New Year’s Eve, a holiday weekend, etc.) or times of day.
  
  
• Plan your traveling times earlier in the day when your mother may be at her best. Make sure you are both wearing comfortable clothes and are well-fed and rested for your journey.
  
  
• Carry all identification, documents and tickets yourself - don’t let your mother be responsible for holding important items. You may also want to bring copies of important health records or prescriptions in case you need to see a doctor while you are away from home.
  
  
• Bring along snacks, puzzles, and books, for distracting your mother while traveling and any favorite or familiar items (pillow, alarm clock, security blanket) that will help your mother feel more comfortable and secure in her new environment.
  
  
• Check with her doctor to see if any medications, such as sedatives, motion sickness medications or anti-anxiety medications, would be recommended for traveling. You may not even use the drugs, but they might be helpful to have on hand.
  
  
• If you are driving, plan your route - know what rest stops, hotels, eating establishments, and medical facilities are along the way. Have a contingency plan in place in the event you have to spend the night in a hotel before arriving at your final destination.
  
  

The holidays can be a fun time for everyone if you set realistic expectations for yourself and your loved one. The noise and chaos of large holiday crowds can agitate and confuse an Alzheimer's patient - particularly if there are a lot of young, excitable and unpredictable children about—so it is best to just try to avoid these situations whenever possible. Consider foregoing crowded holiday parties in favor of small, intimate gatherings with family and friends. Because they may not have seen him in a while, make your loved one’s family and friends aware that he has good days and bad, and that there really is no way to predict which days will be good ones. Try to maintain your loved one’s normal daily schedule as much as possible during the holidays, which may mean arriving at functions late or having to leave early. If you inform your host or guests far enough in advance, they may be more willing to accommodate special requests for scheduling of festivities.

In all instances, try to minimize your loved one’s exposure to excessive noise, large crowds, and chaotic activities by making sure he has a quiet place to retire to if he should become agitated. Along these lines, Alzheimer's patients usually fare better when they are allowed to visit with only one or two guests at a time, which enables them to better focus their attention. When your loved one’s family and friends go to visit with him, encourage them to introduce themselves with not only their names, but their relationship and other useful information. For example, they can say something like “Hi Uncle Joe, I’m your nephew Ralph from Utah. When I was a kid, we used to have a great time fishing together with your brother Todd, my father.” This might serve to jog some memories, and could lead to an enjoyable conversation for both your loved one and the guest.

During the wintertime, it is important to make sure your loved one stays warm and comfortable.

1. Dress them in layers so you can easily add or subtract clothing as necessary. Make sure they have a warm coat, hat, gloves, and waterproof insulated boots.
   
2. Check for drafts -- sometimes their favorite spot to sit near the window can be quite chilly. On that token, if your home tends to be cold in the winter, make sure that at least the bathroom is warm for when your loved one needs to bathe.
   
3. Provide additional blankets within easy reach for the bed should your loved one become cold at night.
   
4. Be aware of the dangers posed from heating sources and holiday decorations. For example, in addition to supervising your loved one around Christmas trees, candles, radiators, space heaters and fireplaces, you may want to consider installing physical barriers to prevent accidental fires or injuries.
   
5. Make sure outdoor walkways are shoveled and free of ice - you may need to hire a service if this is too much for you to handle on your own.
   
6. Minimize the threat of winter colds and flu by getting flu shots and practicing good hygiene - wash your hands (and theirs) regularly or use instant hand sanitizer.
   
7. The winter climate can be quite dry, so make sure to moisturize your loved one’s skin with lotion and lip balm to prevent uncomfortable, itchy dry skin and chapped lips.

There is no specific research linking Alzheimer's disease to the phenomenon of déjà vu, but some researchers think the two may be related through a specific region of the brain involved in memory processing and recognition, the entorhinal cortex. The entorhinal cortex is located within the temporal lobe of the brain, and is near the hippocampus (another brain region involved in memory formation and recall). Interestingly, patients with epilepsy and schizophrenia are known to experience perceptual distortions such as déjà vu. One study found that when the temporal lobes of epileptic patients were stimulated with electrodes, they experienced déjà vu more often when the specific area stimulated was the entorhinal cortex versus the hippocampus or other adjacent brain regions. Alzheimer's disease is known to affect the hippocampus and surrounding areas, such as the entorhinal cortex. Therefore it is possible that deterioration of the entorhinal cortex could lead some Alzheimer's patients to experience persistent déjà vu. This theory, however, has not yet been directly studied.

Alzheimer's disease patients' oldest memories stay with them longer than their more recent memories, so that may be one reason why your friend's mother remembers you as a little girl. There does not seem to be any rhyme or reason as to which persons a patient will remember, and their ability to recognize and remember different people may change from day to day. It is not uncommon, for example, for an Alzheimer's patient to not remember a family member or close friend, yet they will describe with the utmost clarity their first-grade teacher or someone else from their distant past. The fact that she does not recognize her children is not intentional, and it is not meant to hurt them—it is simply a symptom of this terrible disease.

A decrease in appetite can occur in the later stages of Alzheimer's, but there are other factors that could contribute to this condition. Generally speaking, it is not uncommon for elderly patients to lose interest in eating, as their sense of taste and smell may decline over the years, making eating a less desirable experience. If your mother is taking Aricept for her dementia this may account for her loss of appetite as well, because this is one of the reported side effects of the medication. It is also possible that your mother may have difficulty chewing or swallowing her food, or may have mouth ulcers, a dry mouth due to decreased saliva production, or ill-fitting dental appliances—any or all of which may decrease her desire to eat. Additionally, patients with dementia may get confused about what they are supposed to be doing when it is time to eat, or how to use a knife and fork, or they may be embarrassed about not being able to feed themselves properly. Eating with your mother can help her to remember what she is supposed to be doing, as well as provide her with a visual reminder of how to use utensils. Instead of three main meals, try serving her smaller meals more often throughout the day. Also, try limiting any distractions at meal time, such as radio or television, so that your mother can better concentrate on eating.

Please talk to your mother's primary physician about your concerns. Depression can certainly lead to problems with concentration and memory, and it can sometimes take several weeks before an antidepressant begins to work. Forgetfulness and impaired memory can also occur if a person is suffering from chronic stress, sleep-deprivation, metabolic or nutritional disorders, or experiencing side effects caused by prescribed drugs. You should consider scheduling a checkup for your mother if she has not had one in a while. Her doctor may want to adjust her medication or try a different antidepressant.

Before you jump to the conclusion that your mother has Alzheimer's disease, be aware that there are other medical conditions that could explain your mother's recent behaviors. For example, early dementia symptoms such as confusion and memory problems can also sometimes also be caused by hypothyroidism (failure to produce sufficient thyroid hormones) or a vitamin B12 deficiency—both of which are common in the elderly and both of which are treatable. A thorough physical and psychological examination can help to determine what may be causing the behaviors in your mother.

Unfortunately, there is no way to prove whether or not a dementia patient is acting out of character on purpose or not, because dementia itself causes a person to act out of character. Aggressive or argumentative behavior (verbal or physical) is one of the more disturbing and difficult behaviors of dementia. I can understand that it is difficult to deal with someone who is openly hostile just to you, but it will not help the situation for you to fight back. Arguing with your mother-in-law will only make her more agitated, which will probably only serve to increase her hostility toward you.

When you are with you mother-in-law, the best you can do is to try to maintain a calm environment and discuss non-threatening subject matter. A patient's environment—such as constant background TV or radio sound, outside traffic noise, household noise, etc.—can have a significant impact on a patient's mindset. Eliminating or reducing environmental disturbances can sometimes help to reduce agitation as well as aggressive behavior in the patient. Finally, when your mother-in-law becomes angry or argumentative, try redirecting her attention to a new subject.

Valproic acid (VPA) is a drug that has been used to treat epilepsy and bipolar disorder. Researchers at Canada’s University of British Columbia in Vancouver recently discovered that VPA reduced and even slightly prevented the buildup of amyloid plaques in the brains of Alzheimer's disease-model mice when given early on in the disease. Mice given the drug also performed better on memory tests compared to mice given a placebo. VPA is thought to work by inhibiting the enzyme that produces beta amyloid, thereby preventing the accumulation of amyloid protein that becomes toxic to neurons. This study, conducted by Dr. Weihong Song, is published in The Journal of Experimental Medicine.

VPA was previously tested in Alzheimer's disease patients to assess for drug tolerability and to see whether it reduced agitation and aggression. These earlier studies did not look at VPA’s effects on brain plaques. Dr. Wong and his team are enthusiastic about the results in mice and think that the same strategy could prove effective in humans. In fact, a small clinical trial testing VPA’s efficacy on early-stage Alzheimer's disease patients is currently underway.