Ask an Expert about Alzheimer's Disease

Taking full charge of an Alzheimer's disease patient’s care can be a challenge, both emotionally and financially. Many caregivers find themselves overwhelmed by the responsibility, particularly when the patient is in the later stages of the disease when more complications and difficult behaviors are likely to arise. There is no guarantee that your mother will be any happier if she were to come live with you. If she is in the later stages of the disease, she may receive more thorough care at a nursing home with trained staff then at home with just you as the sole caregiver. Taking care of an advanced stage Alzheimer's patient is a full-time job in itself, which means you would either have to take a leave of absence from your current job or find someone to watch your mother while you are working—both of which can obviously be costly options.

What matters here most is your mother’s overall health, safety and well-being. A skilled nursing facility should be able to provide your mother with a safe environment and proper medical care. This is not to say that you couldn’t also provide excellent care for your mother, but only that it will be more difficult for you as a single caregiver to do this than an entire staff at a nursing home can.

If possible, try to determine if there is specific reason for your mother’s unhappiness. Is it that she feels lonely or does she just not like some aspect of the facility? Try to visit her as often as you can and/or stay for longer visits when you do visit. Observe the staff and other patients at your visits. Does the staff seem genuinely caring in their interactions with the patients? Are your mother’s needs met in a timely and compassionate manner? Does the facility make any attempt to provide activities or social stimulation for the patients where appropriate? Is there anyone who routinely cares for your mother whom you can talk to about her behavior when you are not there? Perhaps it is just a matter of modifying some aspects of her care that will make her happier at the facility.

If you do decide to care for your mother at home, you may be eligible to receive some financial assistance for her care. Depending on what program(s) the Alzheimer patient qualifies (Medicare or Medicaid), the caregiver may be able to receive benefits in the way of assistance with caregiving responsibilities. For example, Medicare can cover some of the expenses related to the care of a patient having Alzheimer's disease. For more caregiver information, please visit the Medicare website. There are also several agencies under the Helpful Organizations heading that you can contact and that can help you to identify sources of aide appropriate for your situation.

Additionally, bear in mind that Alzheimer's disease patients are often prone to developing depression. You may therefore also want to speak to your mother’s physician about this, to determine if her unhappiness is in fact caused by mild depression. If so, antidepressant medications may be of help.

Typically, earlier Alzheimer's symptoms include changes in personality and behavior, mood swings, impaired judgment, and difficulty communicating and understanding written material in addition to memory loss. Memory problems can arise from a number of medical and psychological conditions besides Alzheimer's disease. For example, memory impairments can be caused by stress, depression, brain injury, stroke, interactions between medications (or side effects from a new drug), viral infections, hypothyroidism (failure to produce sufficient thyroid hormones), and vitamin B12 deficiency. Many of these conditions can be treated, so it would be in your uncle’s best interest to visit his primary care physician for a thorough examination. Whatever you can do to get your uncle to see his doctor would be the best help you can offer your uncle at the moment.

The sooner your uncle has a medical evaluation, the sooner a diagnosis can be had and appropriate treatment can be started. If the doctors determine that he does in fact have Alzheimer’s disease, many of the Alzheimer's disease medications, when taken early on, may help to slow the progression of cognitive impairment.

Medicare is a federal health insurance program for people age 65 or older who receive Social Security retirement benefits. To receive assistance from Medicare, a person must meet specific eligibility requirements. Medicare covers some, but not all, of the services a person with Alzheimer's disease may require. For example, the program does not cover long term healthcare. Medicaid is a federal program for certain individuals and families with low incomes and resources, typically administered by state agencies; eligibility and benefits vary from state to state. Medicaid can cover all or a portion of nursing home costs. A person with Alzheimer's can qualify for long term care only if there are minimal income and cash assets. Medicaid may be applied for by calling each state's Department of Human Services or Medicaid Assistance Program.

If you visit a new doctor, bring your medical records; for any doctor, bring a list of over the counter and prescription medicines you are currently taking. If you don't know the names of the drugs, bring the pill bottles with you. A medication or a combination of medications can sometimes cause symptoms that resemble Alzheimer's disease. Also make a list of current medical problems. It's a good idea to show the doctor a list of symptoms, behaviors and any problems carrying out routine activities (for example, paying bills) in yourself or your loved one that concern you.

Alzheimer's disease can certainly affect the ability to speak in a patient. Speech problems typically arise in Stage 2 of the disease, wherein patients may forget words for things or speak nonsensically. Complete loss of speech can also occur depending on what part of the brain is affected by the disease.

Alzheimer's disease medications in general help to slow the progression of the disease, and therefore may aid in slowing the decline in communicative ability. You should consult with your mother’s prescribing physician for more information. However, since your mother may be in a later stage of the Alzheimer’s disease, the medications may not be as effective as in earlier stages.

Alzheimer's disease and type-2 diabetes mellitus (T2DM) do share some pathological and biochemical similarities. For example, both diseases are known as amyloidoses in that both are characterized by an abnormal deposition of amyloidogenic proteins—amylin deposition in pancreatic islets in T2DM, and amyloid-beta protein deposition in the form of plaques in Alzheimer's disease brains. Also, when deposited in and around cells, both types of proteins are toxic and cause cell death—pancreatic beta-cells in T2DM and neuronal brain cells in Alzheimer's disease. The similarities between the two diseases and their associated amyloidogenic proteins have lead researchers to question whether there are other shared cellular or molecular mechanisms underlying their pathologies, and how such findings might influence the development of effective therapies for each of these diseases.

In addition, epidemiological studies suggest that metabolic syndrome (characterized by the “deadly quartet” of factors including high blood pressure, dyslipidemia, central obesity and insulin resistance), which is predictive of T2DM, may also be predictive of and/or increase the risk of vascular dementia, stroke, and even Alzheimer's disease. Taken together with the above evidence, it is understandable how some people actually consider Alzheimer's disease to be a form of “diabetes of the brain.”

Paranoia and other psychiatric behavior is more often an initial symptom of frontal lobe dementias, such as Pick’s disease, than of dementia caused by Alzheimer's disease.

Psychosis and paranoia can occur in other forms of dementia and in Alzheimer's disease, but usually only after the disease has progressed for some time. For example, because they may no longer be able to rationalize what they see or remember who people are, Alzheimer's patients commonly report that people are stealing from them or that there are strangers in their home. In fact, these patients most likely just forgot where they put their items or do not recognize their own reflections in the mirror.

Interestingly, it has been reported that there is a higher risk for schizophrenic patients (who commonly suffer from paranoia) to develop dementia later in life. Several studies have indicated, for example, that when schizophrenia develops late in life (>60 years), there is a higher likelihood that dementia will also be diagnosed.

Medium-chain triglycerides (MCTs) are quickly metabolized by the body to form ketones (also known as ketone bodies). Normally, the brain uses glucose as a primary source of fuel. Researchers believe that brain cells (neurons) altered by Alzheimer's disease are not able to adequately metabolize glucose and therefore perform more poorly, which can lead to cognitive impairments. MCTs converted to ketones by the liver can therefore serve as an alternative fuel source for neurons, allowing them to function better. Besides Alzheimer's disease, the “ketogenic diet” approach has been investigated as a therapy for a number of neurological and metabolic disorders, including intractable epilepsy and phosphofructokinase deficiency, with positive results.

Two recent clinical studies demonstrated that patients having probable Alzheimer’s disease or mild cognitive impairment (MCI) had improvements in cognition and memory when given a medical food containing MCTs. Researchers believe that the ketogenic diet may actually be neuroprotective, and may therefore be beneficial not only for the treatment of neurodegenerative disease, but also in instances of stroke and brain injury. In addition, one study in animals found that ketones can reduce brain beta-amyloid levels, which if true in humans, may also be very beneficial in the treatment of Alzheimer’s disease.