Ask an Expert about Alzheimer's Disease

Many investigators and clinicians suspect that diet may have a connection to Alzheimer’s disease, though it is unlikely that diet is a primary cause. A recent National Institutes of Health conference on “Preventing Alzheimer’s Disease and Cognitive Decline” reviewed current data on this issue and concluded that there is preliminary evidence to support the idea that the Mediterranean diet, which is high in vegetables, fish, fiber, and healthy oils, may be associated with a decreased risk for cognitive decline or Alzheimer’s disease. By contrast, there was a suggestion that high intake of saturated fats and trans-fats might increase this risk. Some investigators have explored the idea that a “ketogenic diet” might benefit Alzheimer’s disease by providing the brain with an energy source other than the usual glucose (which is handled less effectively by the brain in Alzheimer’s disease). A prescribed “medical food” that induces ketosis is available but further studies are needed to fully assess its safety and effectiveness. In general, there is no rigorously documented prevention strategy for Alzheimer’s disease in humans; however, some preliminary data from animal studies show exiting promise. Much further research is necessary to confirm these findings.

For reasons not fully understood, Alzheimer's disease frequently disrupts a patient’s circadian rhythm (our internal clock that helps regulate day-night awareness/activity), which then results in patients being awake at night and sleeping during the day. Regular exposure to sunlight can help to improve an Alzheimer's patient’s overall mood and – when combined with calming, dim lighting in the evening – can help to keep a patient’s circadian clock on track.

Several studies also seem to indicate that the use of bright lighting in the patient’s home environment (or care facility) improves sleep quality in dementia patients, presumably by normalizing the day-night cycle. For example, bright lighting improved facility patients' sleep patterns (longer nighttime sleep with fewer nocturnal sleep interruptions), reduced patients' agitation, and lessened the incidence of depression.

Additionally, physical activity during the day can help to improve or regulate nighttime sleep. So try to encourage the patient to participate in some sort of physical exercise every day.

Dementia is a term that describes a condition of decline from previous cognitive functioning, not explainable by adverse medication effects or other simple reversible medical causes. In addition, it is characterized by memory problems and problems in one or more other areas such as recognition, ability to do learned tasks, use language, or to problem-solve. Alzheimer's disease is the most common of dementias in the elderly, accounting for about 2 out of 3 cases, but there also are other conditions that can cause dementia. "Stage 4 Dementia" refers to moderately impaired cognitive and social functioning as described in Dr. Barry Reisberg's "Global Deterioration Scale." At stage 4, we'd expect to see decreased knowledge of recent events, impaired problem-solving ability, trouble with tasks such as bill paying, reduced memory, and a tendency to withdraw from challenging situations. Orientation, recognition of familiar people, and ability to travel to familiar places are typically preserved at this stage. This staging system is usually used to describe the progression of Alzheimer's disease, since symptom progression can be somewhat different in some other dementias.

Zinc, like many trace elements required by the human body, is a necessary ingredient in some physiologic processes but potentially dangerous at toxic levels. At appropriate levels zinc facilitates learning through a process called "long-term potentiation," but zinc is also an important component of the amyloid plaques found in Alzheimer's disease. An experimental medication that lowers zinc levels, clioquinol, has been claimed to show some promise in treating Alzheimer's disease, but this is based on very limited and preliminary results. If you like oysters, you should know that a half-dozen contain about twice the zinc present in your wife's pill. In any case, the effects of zinc on memory are thought by some researchers to depend on internal regulatory processes rather than exposure through food or supplements; however, this remains an area of controversy awaiting resolution.

Double vision is a rare occurrence in mild Alzheimer's disease, and the onset of double vision should prompt a visit to the ophthalmologist to rule out other causes of this disorienting and distressing symptom. The list of causes for double vision (diplopia) is very long and includes many conditions that affect the cornea, lens, muscles that move the eye, tissue around the eye, or brain. In addition, double vision might suggest the need to consider some other dementias that are not Alzheimer's disease, such as supranuclear palsy or Lewy body disease.

Acetylcholine is an important neurotransmitter in the brain and its availability is decreased early in Alzheimer's disease. This observation, noted several decades ago, led to widespread experiments aimed at increasing acetylcholine at the synapse (the structure where chemical information is passed from one nerve cell to another) by providing the ingredients from which the brain could produce this neurotransmitter. Other experiments sought medications that would slow down the destruction of acetylcholine present in the diseased brain. This slowing down of destruction of acetylcholine, by inhibiting the enzyme that breaks it down (called cholinesterase) is the mechanism of action of widely used medications for Alzheimer's disease: donepezil (Aricept), rivastigmine (Exelon), and galantamine (Razadyne). But the limitations on the effects of these medications, along with newer findings, has led researchers to believe that other basic brain changes result in the acetylcholine scarcity. The lack of acetylcholine is thought to be an important step in the disease process but not a "cause" of Alzheimer's disease.

It can be very difficult to speak openly with someone who is suffering from Alzheimer's disease. However, if this diagnosis has been confirmed by a doctor—rather than just something you suspect—then I believe you have a moral obligation to tell the person. If you prefer not to be the bearer of bad news, ask his or her doctor to do it. The patient will have to come to terms with this information in his or her own time, and it will undoubtedly be difficult. You can be there to give the patient the support he or she will need. Our organization provides information on the progression of Alzheimer's disease, such as “Alzheimer's Symptoms and Stages" which may be useful in talking with this person.

Unless it is a subject that clearly upsets or agitates the patient, there should be no harm in talking about past events. In fact, Alzheimer's disease often attacks short-term memory and spares a patient’s long term memory, such that they can remember the distant past but have trouble remembering what was done just 5 minutes beforehand. So the patient may be able to more easily engage in conversations about the past than in current topics.

In most circumstances, the spouse takes precedence over other relatives (children, siblings, etc.) in the right to make medical decisions should the patient become incapacitated. Depending on the state, however, this does not always hold true for same-sex marriages.

Unless her spouse strongly objects, it is possible that you or one of your siblings could obtain a durable power of attorney for health care of your mother, which would give you the legal right to make medical decisions on your mother’s behalf. Please consult an attorney specializing in elder issues for more information. For example, you might consider the following sources:

ElderLawAnswers.com: This organization supports seniors, their families and their attorneys in achieving their goals by providing information concerning crucial legal issues facing seniors and a network of highly qualified elder law attorneys nationwide. You can access their website at: www.ElderLawAnswers.com.

Administration on Aging: This agency, part of the U.S. Department of Health and Human Services, is one of the nation's largest providers of home- and community-based care for older persons and their caregivers. AoA also provides some legal assistance. Their phone number is (202) 619-0724. You can access their website at: www.aoa.gov/. The AoA website can also lead you to state agencies.