Questions & Answers

Researchers at Columbia University in New York recently reported that a drug belonging to a class of agents used for treating cancer can improve the memory of transgenic mice that are a model of Alzheimer’s disease (AD).

The drug is a histone deacetylase (HDAC) inhibitor. The researchers noted that transgenic AD mice had lower levels of acetylated histone 4 (called H4) in their brains than wild-type (non-transgenic) mice. Acetylated histone is required for the synthesis (production) of new proteins by brain cells. The researchers believed that the memory impairments observed in AD patients (and in the transgenic AD mice) is due to a defect in the ability of their brain neurons to synthesize new proteins, which is critical for the process of making and retaining memories. The researchers tested their hypothesis by giving an HDAC inhibitor (which blocks the breakdown of acetylated histone, thereby allowing more of it to be available in the brain for protein synthesis) to the AD mice and then testing their memory. The AD mice administered the HDAC inhibitor scored as well as the wild-type (non-diseased) control mice on the memory tests, thus indicating that HDAC inhibitors can improve memory functioning in individuals the animals with impaired memory.

Clearly, the findings of this study have implications for Alzheimer’s disease patients in terms of a potential new therapeutic approach. But it also clear that additional research will have to be performed to validate these results in other animal models and then in humans. One good thing, the drug used in the study has already been approved as safe for human use for the treatment of certain forms of cancer, so that that puts it one step closer to its potential use as a treatment for Alzheimer’s disease.

On a day to day basis, an Alzheimer’s disease patient’s memory can definitely fluctuate. In extreme cases, one day a patient may know his spouse caregiver, the next day he may think that same person is an intruder in his home. However one thing is consistent: if you were to chart the overall memory capacity of an Alzheimer’s disease patient, you would certainly see a gradual decline over a long period of time (e.g., months or years).

There is at least one published case report indicating that Demerol® (generic name merperidine) can cause the confusion of dementia to worsen. As an alternative, the study suggested that Percocet should be offered. In general, however, the benefits of managing or reducing pain in dementia patients to improve their quality of life far outweigh any potential side effects the pain medications may produce. When used responsibly and under the supervision of a doctor, pain medications can play a vital role in reducing or managing pain, thus allowing the dementia patient to perform more activities (both assisted and unassisted) and to be more willing to interact socially with others.

During the final stages of Alzheimer's disease, it is not uncommon for patients to stop eating and drinking, as they often lose the ability to chew and swallow. Depending on how much reserved fat a person has, it is possible for a person to last a few weeks without eating, though the body will weaken considerably as time goes on. Hydration, however, is another issue. Generally, most people cannot survive more than a few days without water or fluids.

However, you may want to have a doctor assess if your mother-in-law still has the capacity to swallow on her own. If she can still swallow properly, for instance, then it may be possible to provide her with assisted feeding (i.e., hand feeding), which may of benefit to her due to the human contact involved with hand feeding the patient. Your mother-in-law’s physician, along with a specialist such as a speech therapist, can help to determine whether hand feeding is an option based on whether or not she is still physically capable of swallowing. Such specialists can also demonstrate the proper techniques for assisted feeding. If, however, your mother-in-law can no longer swallow correctly anymore, then a feeding tube may be an option for consideration. For the caregiver of a dementia patient, deciding on whether or not to use a feeding tube can be a very difficult decision. So be sure to discuss this decision thoroughly with the your family and doctor, taking into account whatever your mother-in-law’s wishes or preferences—stated or otherwise—on tube feeding may have been. Please also consider talking to a counselor, your family or friends, or if you prefer, a family cleric for support and guidance during this time.

In some respects, how you would care for an Alzheimer's disease (AD) patient is not so different from any of the other patients you may deal with. For example, you should always treat AD patients with dignity and respect deserving of any other non-dementia patient, even if you think that the dementia patient can no longer comprehend your words or actions.

The biggest aids in working with AD or dementia patients are to develop a good rapport and to establish an effective means of communication. The AD patient may not be able to verbalize (or adequately verbalize) what they do or do not want, or what may cause them discomfort. Therefore, it is important that you speak in a clear, calm voice when explaining what it is you want the patient to do. Try to explain what you want them to do in terms of activities they might actually perform on a daily basis (i.e., brushing their hair, pouring milk onto cereal, etc.), or divide the activity into simple and easy to follow steps. Use simple commands and be sure to engage them directly, making eye contact, when you ask them to perform a task. The tone of your voice may be just as important as what you are saying, so always be sure to use a calming, pleasant voice. Avoid talking down to the patient, belittling their condition, or talking to others about them as if they were not there.

You and your fellow staff should insist that the facility’s management provides at least some form of specialized training for caring for dementia patients, even if it means that you or one of the staff has to deliver the training presentation yourself. Properly trained staff will not only be able to provide more effective care, thus ensuring a better quality of life for the patient, but also will help to improve confidence and coping strategies among the staff when working with dementia patients. The following training resources may be of help:

• Dementia Care Training Manual for Staff Working in Nursing and Residential Settings, by Danny Walsh. Jessica Kingsley, publisher. ISBN-10: 1843103184, ISBN-13: 978-1843103189
• Teaching Dementia Care: Skill and Understanding, by Nancy L. Mace. The Johns Hopkins University Press, publisher. ISBN-10: 0801880432, ISBN-13: 978-0801880438
• Dementia Care: InService Training Modules for Long-Term Care, by Jackie Nasso. Delmar Cengage Learning, publisher. ISBN-10: 1401898580, ISBN-13: 978-1401898588

Tell your husband that someone is coming to visit to help you with the housework because you are finding it too challenging to manage on your own. If possible, speak to the respite caregiver or agency to let them know about your husband’s reluctance to accept a respite caregiver. They may have some suggestions on how they normally proceed in this situation (which, by the way, is fairly common). You may want to keep the first few visits short—maybe only an hour or two—so as to ease your husband into the idea of having someone else in the home. As your husband becomes more comfortable with the aide, you can increase the length of time that the aide stays to help out.

Another option is to have your husband visit an adult care center for a few hours each week. These facilities have staff members who are experienced in caring for dementia patients, and generally offer social activities befitting of Alzheimer’s patients. You can tell your husband that it is a social club.

Patients in the later stages of Alzheimer's disease are easily confused, so moving such a patient to from one living facility to another can be challenging but it is not impossible.

Your father may be anxious or confused by his new surroundings initially, but with time he can be aided in accepting them as his new "home." Try to visit him frequently in his new home, and speak enthusiastically about how nice the new place is. Immediately following the move, try to get him back on his regular schedule as soon as possible. The more things that are "familiar" to him in the new environment, the sooner he will come to accept it as home. You can also ask the directors of both his current and new facilities for help in objectively assessing how best to manage the move, and also about any suggestions they may have to make the transition more seamless.

Aricept (donepezil), an Alzheimer's disease treatment appears to have a slowing effect—though limited—on the progression from mild cognitive impairment (MCI) to Alzheimer's disease, according to a study published in April 2005 by the New England Journal of Medicine. Those with MCI, such as the study participants, experience memory problems, but are able to function independently; however, MCI is often a transitional stage that leads to the serious cognitive decline of Alzheimer's disease. Over the first year of the three-year trial, MCI patients treated with Aricept had a reduced risk of progressing to Alzheimer's disease compared to patients who took a placebo, an inactive pill. The study found the effect of the Aricept treatment lasted longer (up to two to three years) in those patients carrying the ApoE4 gene. Previous studies have shown that those with the ApoE4 gene have a higher risk of developing Alzheimer's than the general population. Source: Mayo Clinic, Rochester and the National Institute on Aging