Questions & Answers

Lipogen PS is composed primarily phosphatidylserine, a constituent of biological membranes. Lipogen PS is soy derived but there is no evidence that it is more effective than phosphatidylserine from other sources. These agents have been reported to give modest and temporary improvement to patients with early symptoms of dementia.

There are no recommended and effective dietary treatments for patients with Alzheimer's disease; however, there is good evidence that a balanced diet that contains monosaturated fats (found in the Mediterranean diet) reduces risk of developing this neurodegenerative disease.

There is a considerable body of literature suggesting that modest memory impair can occur in the normal person or animal after general anesthesia. This usually is not debilitating and diminishes in severity over a period of months. Your wife's case is an unusual one in the fact that the decline in her function was so profound. The brain of a demented person has much less "reserve" than that of a normal person of the same age. A drop in blood flow under anesthesia or other effects of the anesthetic on structural proteins of the nerve cell could underlie these changes. The anesthetic does not remain in the system for a prolonged period after surgery so it is unlikely that its effect can be reversed. Without examining your wife, it is extremely difficult to be specific about what has happened and what might be done. I would suggest that she be thoroughly evaluated by a neurologist or other physicians with experience in dementia.

While some studies have suggested that tobacco use (and in particular cigarette smoking) may actually reduce the risk of developing Alzheimer’s disease (AD), more recent studies have found this to be incorrect. Earlier research may have been biased on some factors (for example, the authors conducting the research were affiliated with the tobacco industry). Also, because non-smokers generally live longer than smokers, the occurrence of age-related diseases such as Alzheimer’s disease may be biased to reflect more non-smokers having AD. When these and other factors are taken into account, the most recent evidence indicates that cigarette smoking is indeed a risk factor for AD. Unfortunately, however, these studies were mainly focused on cigarette smoking. None of the research so far has looked into snuff use as a risk factor for Alzheimer’s disease.

Interestingly, nicotine - one of the main chemicals found in tobacco - is known to improve concentration, coordination and short-term memory. Researchers therefore became interested in using nicotine therapeutically, such as for the treatment of neurodegenerative disease. These results are also mixed. Some studies have found that Alzheimer’s patients (or transgenic mouse models of AD) show improvements with chronic nicotine treatment, while other studies have found no beneficial effect. Therefore, more research is clearly needed to determine if nicotine can impact the course or progression of AD.

That being said, could snuff use have influenced your husband’s disease onset or progression? It is quite possible that it did, however, without more research on the effects of smokeless tobacco on neurodegenerative diseases, it is impossible to say just how (positively or negatively) snuff use affected your husband’s disease.

Unfortunately, as an Alzheimer’s patient’s cognitive capacity declines, so do other regulatory brain controls, such as those regulating urinary and bowel functioning. First try to determine if there is any pattern to the incontinence: does it occur more frequently at a particular time of day or night? What is your father’s mental and emotional state during these occurrences? What types of foods and beverages were consumed that day? And so on. Relay this information to your father’s primary care physician, who may be able to determine if there is a medical reason (besides dementia) for your father’s fecal incontinence.

If your father is actually still aware of his bowel functions, then it may be beneficial to put him on a regular toilet schedule so that perhaps any accidents could be avoided or minimized. The aide can help with making sure your father uses the toilet at least once or twice during the visit. It may also be of benefit to arrange for an aide to stay with your father for a longer period of time while you are away at work.

Make sure that your father has easy access to a toilet and that the bathroom and toilet itself are visible and labeled if necessary. If your father has difficulty removing his clothing to use the toilet, then replacing difficult zippers and buttons with Velcro closures could help. If you choose to use adult diapers, you will need to fully explain to you father how they are used and what is to be done with them when they are soiled. Do not expect him to automatically know these things. Practice using them when you are present, so that he can become more comfortable with their use.

Finally, it could be of benefit to reassess his diet. Too much or too little fiber can cause frequent bowel movements or constipation, respectively, which can lead to other problems such as incontinence. Again, this is where assessing his toileting habits may be useful, as this information could provide some insight as to why the incontinence may be happening. Your father’s doctor may be able to provide you with information on potential treatment options should the problem be found to be medically related.

On average, patients with Alzheimer's disease live for 6 to 10 years following diagnosis, although some patients live as long as 20 years. So although it may seem unusually long since her diagnosis, the length of your wife’s disease is still within an average range. How long your wife will continue in long-term care is dependent upon her general health prior to being diagnosed, how quickly the disease has thus far progressed, and other complicating conditions or diseases she may have.

Not all dementia patients develop sleep disturbances such as roaming, so the fact that your husband has not developed this behavior is good but does negate a diagnosis of dementia. Doctors usually perform a battery of cognitive and physical tests to arrive at a dementia diagnosis, so again, it is unlikely that the absence of a potential symptom (nighttime wandering) rules out that a patient has dementia.

Normal Pressure Hydrocephalus (NPH) has symptoms very similar to Alzheimer's disease—such as progressive mental deterioration leading to dementia, difficulty with walking, and even incontinence—which is why NPH is oftentimes misdiagnosed for Alzheimer's disease. Another common symptom of NPH is an abnormal, shuffling-like gait or difficulty walking (similar to Parkinson’s disease). NPH is caused by the gradual build up of cerebrospinal fluid (CSF, the fluid that bathes and protects the brain and spinal cord) when the normal drainage or circulation of CSF is somehow blocked. Unlike Alzheimer’s disease, however, NPH is often treatable. If your husband displays a shuffling gait or has other problems associated with the control of his legs and lower extremities, you may want to contact his doctor to test for NPH.

It is not uncommon for Alzheimer's patients to experience hallucinations. Reports indicate that just under half of patients diagnosed with Alzheimer's develop some hallucinations that are either visual and/or auditory in nature, and which generally occur in the mid- to later-stages of the disease. Alzheimer’s patients may report hearing the voices of loved ones or friends, which are generally not disturbing to the patient. In your mother’s case, the sounds or voices she may hear are obviously causing her to become agitated and distressed.

You may want to speak to your mother’s physician to determine if an anti-anxiety medication may be of value. It may help to reduce her agitation and allow her to sleep better. Anti-psychotic drugs are also often prescribed for reducing the occurrence of distressing hallucinations. However, anti-psychotic drugs do have real risks associated with their use in cognitively-impaired elderly patients, such as an increased risk of death in dementia patients. Therefore, you and her doctor should thoroughly discuss all possible behavioral treatments before resorting to anti-psychotic medications, and also whether the potential benefits to your mother’s well-being outweigh the risks of their use.

On average, patients with Alzheimer's disease live for 8 to 10 years after diagnosis, and the majority of people who are diagnosed are at least in their mid- to late-sixties. However, this terminal disease can last for as long as 20 years.