Questions & Answers

The gene called Apolipoprotein E (ApoE) appears to be a risk factor for the late-onset form of Alzheimer's disease. There are three forms of this gene: ApoE2, ApoE3 and ApoE4. Roughly one in four Americans has the ApoE4 gene and one in twenty has ApoE2. While inheritance of ApoE4 increases the risk of developing the late-onset form of Alzheimer's disease, inheritance of ApoE2 substantially protects against the disease. Therefore, even though you have the ApoE4 gene, it only means that you have a slightly higher risk of developing Alzheimer’s disease than the general population. There is no need to be retested because the results would be the same. Having the ApoE4 gene does not mean that you will definitely get Alzheimer’s disease. Remember that about a quarter of the population have the ApoE4 gene—the majority of these people never go on to develop Alzheimer’s disease.

Although there is no sure-fire way to completely prevent Alzheimer’s disease, research findings generally suggest that the best approach to reducing your risk of developing Alzheimer's involves a combination of measures normally thought of as good for maintaining a healthy heart, such as eating a healthy diet that is low in saturated and trans fats, exercising regularly and reducing stress. Foods that are rich in antioxidants have also been reported (though not proven) to help reduce the risk of developing Alzheimer's disease. Foods considered antioxidant-rich include blackberries, blueberries, spinach, strawberries, red bell peppers, walnuts, artichoke hearts and tomatoes, among many others. Green tea, dark chocolate and red wine all contain antioxidants too.

Exercise, both physical and mental, has emerged as a possible preventative measure against developing Alzheimer's, as has reducing stress. Maintaining a relaxed attitude can help to lower stress levels, and lowering stress is beneficial overall for your body and mind. A calm, non-stressed person will typically have lower stress hormone levels and lower blood pressure, which is good for your heart, your immune system, and your brain among other things. For example, lower blood pressure can reduce your risk of heart disease and stroke, both of which have been implicated as potential contributing factors for the development of dementia. And having a relaxed attitude is good for your memory as well. Studies have indicated that reducing stress not only acts to aid short-term memory, but can also improve a person’s general emotional well-being, which is good for long-term cognitive health.

So eating a healthy diet rich in antioxidants and low in saturated and trans fats, exercising both body and mind, and reducing overall stress all may contribute to lowering a person's risk of developing Alzheimer's disease.

Psychosis, paranoia and memory loss can occur in both schizophrenia and dementia, particularly as a patient ages and the associated risk of developing dementia increases. As you mentioned, there is a definite higher risk for schizophrenic patients 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.

Because of the overlapping nature of the diseases, research has focused on whether or not there are underlying causes in common, such as genetic or early environmental influences on the development of the brain. Scientists are also trying to determine if the same or similar genes are involved in psychiatric and neurological disorders, and also whether or not these genetic targets could be used either to develop new therapies or to provide better diagnostic techniques. Once researchers can determine the shared pathways that many of these neuropsychological diseases affect, it will only be a matter of time before new and better treatments are found.

Unfortunately, there is no rhyme or reason with this disease—some patients can go on for years with seemingly little decline, and others may progress much more rapidly. A traumatic life event—such as the death of a loved one—cannot in and of itself cause Alzheimer's disease or dementia in general, but it can exacerbate the symptoms of a patient who already has the disease. The death of your brother could have easily triggered a bout of depression in your mother, which could have worsened her memory problems, making them more noticeable to yourself and others.

Many caregivers have reported that their patients sleep quite a lot during the day and feel tired all the time. Sometimes this is a side-effect of one or more of their medications, and sometimes it is because they are mildly depressed. Therefore, you may want to contact your husband's primary care physician to let him or her know what is going on with your husband. Perhaps an adjustment to his medications may help, or if he is not on any medications, the doctor can evaluate your husband for signs of depression. Antidepressants may be helpful in this case.

In the meantime, make sure your husband gets exposure to bright light (or sunshine) during the day and dim, calming lighting in the late afternoon and evening. This can help to keep a patient's internal clock set correctly so that, ideally anyway, they will want to sleep at night and stay awake during the day. You can also encourage your husband to perform some sort of physical activity during the day, as exercise can aid in establishing good sleep patterns. However, try not to overtire him with the activities, as this can be counterproductive and lead to more napping throughout the day.

The unfamiliar surroundings of new home environment such as an assisted living facility, for example, can confuse and frustrate an Alzheimer's patient who has not come to fully accept their new circumstances. Patients can feel trapped and restricted by this type of environment, and can become anxious as a result. They may also feel as though they have been "set aside" and forgotten about in a facility or that they are being punished for something they have done, regardless of the level of caregiver skill or amount of care provided.

Because of the nature of the disease, patients will often have their oldest memories still intact—such as of their old homes. Perhaps their memory of "home" is a place where they felt safe and useful. Also, it is not uncommon for patients to want to assume the role of caregiver for other (usually long-deceased) loved ones. Whether or not they are overtly aware, the patient may feel alone, sad, and anxious over their impending fate. The patient may feel a sense of duty or responsibility toward these loved ones (or an old job, etc.) and therefore wants to go to them to fulfill this responsibility and perhaps feel useful again. Their desire to "go home" then most likely stems from their unease of their current surroundings. They need to be made to feel more at-home in their current environment.

Caregivers can help to make patients feel more at-home by getting patients involved in daily activities, by providing continual reassurance of the patients' general safety and value to society as a whole, and if there are other patients, helping them all to feel a sense of togetherness with their new "family". Additionally, the more freedom and responsibility (within reason, of course) a patient has in his daily routine, the more it may help him to feel at-home. For example, a patient should be encouraged to dress and groom himself to the best of his ability each day. This can help to give the patient a sense of self-reliance, accomplishment and worth, which can all help to increase their "at-home" feeling.

Because of the brain areas that are affected by the disease, Alzheimer's disease often results in patients becoming bedridden prior to death. So unless the patient succumbs to some other condition prior to being incapacitated by Alzheimer's disease, it is likely that he or she will be bedridden by the final stages of the disease.

Several studies have attempted to determine whether or not there is a correlation between worsening vision and the development of dementia. For example, some studies have focused on the relationship between either macular degeneration or cataracts and cognitive impairments in elderly patients. Although Alzheimer's disease and age-related macular degeneration may share similar pathology, there does not seem to be an association between cognitive impairment and age-related macular degeneration. That being said, however, there does seem to be an association between certain cataract formations in the eye and Alzheimer's disease. Cataracts are a clouding of the eye lens, which can give the eye a grayish-whitish appearance.

The amyloid beta protein associated with Alzheimer's disease (AD) has been found to be present in the cataracts of both AD patients and non-AD subjects. A team of investigators lead by Dr. Lee Goldstein, however, has discovered that there may be a way to detect Alzheimer's disease in patients with cataracts. The researchers report that cataracts of AD patients were found as an arc around the rim of the lens, which is different from the “normal” cataract occurring in the center of the lens. Dr. Goldstein has developed a test using fluorescence particles injected into the eye and a special light that causes the particles to glow. The fluorescence pattern is then used to determine whether or not the cataracts are indicative of Alzheimer's disease. This work is still in the experimental stages, however, and further research will help determine the whether this strategy could be used for routine diagnosis of AD.

On behalf of its donors, the American Health Assistance Foundation (AHAF) is proud to have funded Dr. Lee Goldstein's project related to this topic, titled "NonInvasive Laser Technology for Alzheimer's Diagnosis."

I am very sorry for your loss! The way to identify Alzheimer's disease (AD) until this day is postmortem examination of the brain. I don't think Aricept or Namenda will cause Alzheimer's disease in normal individuals. AD is a very complex disease and researchers are working on different projects worldwide in order to understand the causes and pathology of AD. Hopefully, we will have more accurate diagnosis method and efficient treatments of AD in near future.